Hypospadias, also known as hypospadias, is a common birth defect of the penis in children. This defect is characterized by the presence of the urinary opening (meatus) in an abnormal location, usually on the underside of the penis near the head of the penis. In some cases, the opening may be in the middle or at the base of the penis, and in rare cases, it may be located inside the scrotum. In this article, we will review the most common questions parents ask about this condition in Dalili Medical.

What is hypospadias?

 

Under normal circumstances, urine and semen are transported through the urethra, also known as the urethra, which is the tube that runs inside the male penis, to the outside through the urethral opening, known as the meatus, which is located at the tip of the head of the penis (glans). However, this is different in children who are born with congenital penis defects, which occur during fetal development in the womb. This is caused by the tissues on the underside of the penis not closing completely, which leads to partial or complete blockage of the urethra, thus shortening the passage (urethral tube) and not having the meatus or urethral opening in its normal location at the tip of the penis.

What is the appropriate age for this surgery in children?

 

This surgery can be performed on children between the ages of 6 and 18 months. It is preferable to circumcise a newborn male at an early age, as the procedure is easier than waiting for the child to get older.

The surgery is usually performed under general anesthesia, and the child can go home the same day.

How does a normal penis work?

 

The main function of the penis is to transport urine and semen out of the body through the urethra, where both fluids exit through the urethral opening at the tip of the penis. In the case of hypospadias, things are a little different.

** Does surgery affect my child's circumcision?**

 

It is recommended that children with angelic circumcision not be circumcised before surgery, as the foreskin may be necessary to take tissue during the operation, which is used in the reconstruction and lengthening of the urethra.

** How do I care for my child's wound after surgery?**

 

In general, there are no specific instructions for caring for the child's wound or to speed up the healing process. The treating physician will guide you on the appropriate methods for caring for the wound and bathing the child, depending on the type of surgery performed and your child's condition. In some cases, the physician may need to install a catheter, in which case you may be asked to use and change diapers as usual. If your child is older, the catheter will be attached to a bag that is emptied according to the physician's instructions.

The catheter placement period usually lasts from 6 days to 2 weeks.

- What is the function of the urethral opening?

 

The urethra is a canal that connects the bladder to the external environment, and its opening performs two functions: the first is related to getting rid of urine, and the second is related to sex, as semen passes through it in males.

Does surgery affect sexual sensation and the ability to reach orgasm in the future?

 

The surgical procedure used to treat the condition in children does not affect sexual sensation or the ability to reach orgasm during sexual intercourse.

How long does the angelic circumcision procedure take?

 

The procedure takes between three and six hours, and has a very high success rate of more than 95%.

Does circumcision affect the length of the penis?

 

The procedure does not shorten the penis, but if an error occurs while modifying the urethra, it may lead to shrinkage of the penis during erection. This can be corrected through another procedure, but it is better to avoid such problems by performing the procedure by an experienced doctor.

**Does hypospadias affect marriage after treatment?**

 

Treatment of hypospadias depends on the type and severity of the condition (mild, moderate, or severe). In most cases, surgical treatment is used to correct the location of the urethral opening. The doctor usually performs the operation when the child is between 3 and 8 months old, and in some severe cases, it may be necessary to perform the repair in stages. The doctor may use skin from the genital area, so it is preferable to postpone circumcision of the child. If the operation is successful and the patient regains the natural location of the urethral opening, he can continue his life and have sex normally, while maintaining his ability to reproduce, unless there are other diseases that affect the semen.

**Does hypospadias affect marriage without treatment?**

 

Some patients can reach marriageable age without treating hypospadias, as the effect of this condition on the marital relationship and reproduction varies according to its type. In simple cases, intercourse can take place normally and fertility is normal. This is because the urethral opening is close to the head of the penis, and these cases are not usually accompanied by a curvature in the body of the penis. In other cases, its effect varies depending on the location of the opening

How can I be sure that the hypospadias surgery was successful?

 

The ideal outcome of the surgery is to have a urinary opening close to the normal position, in a suitable place, which allows for regular urination, in addition to having a member capable of performing the sexual process well.

When does the hypospadias surgery wound heal?

 

The angelic circumcision wound takes about six weeks after the surgery to heal.

When do the stitches fall off after circumcision?

 

The stitches need about seven to ten days after the hypospadias surgery.

**Grades of hypospadias**

The degree and type of hypospadias injury varies depending on the location of the urethral opening. The degrees of the condition include the following:

- **Mild degree (Subcoronal)**: In this case, the urethral opening is not in its normal location, but remains close to the head of the penis, which is known as simple hypospadias.

- **GradeMidshaft**: In this case, the urethral opening is located somewhere along the penis instead of its normal location.

- **Penoscrotal**: In this case, the urethral opening is located in the area where the penis meets the scrotum.

**Problems that may accompany hypospadias**

 

This type of deformity is often associated with other deformities, including:

- Curvature of the penis.

- Difficulty urinating, which may reach the need to sit down to urinate without mess, which is a possible complication of hypospadias surgery.

- The testicles not fully descending into the scrotum.

If this deformity is not corrected, it can lead to many difficulties in the man's life, and negatively affect his sexual life.

**Diseases associated with hypospadias**

 

The process of developing the penis and urethral opening in the male fetus occurs between the 9th and 12th weeks of pregnancy. Therefore, if any defect occurs in this development, other problems may appear in addition to the hypospadias, including:

. **Penile curvature** This is a physical problem in which the penis bends during erection, and is often diagnosed after puberty. The curvature can occur downward, upward, or to one side. In all cases, the degree of curvature may affect the sexual intercourse process, as mild degrees may be unnoticeable and do not affect sexual practice.

. **Cryptorchidism** Also known as undescended testicle, this condition is represented by the failure of the testicles to descend to their normal location inside the scrotum. This problem is usually discovered during the infant's examination after birth. As for treatment, it depends on the severity of the condition. Sometimes, it is possible to wait several years before deciding to undergo surgical intervention, as the testicle may descend naturally during the first year to a year and a half after birth. However, after this period, surgical intervention becomes necessary to preserve the ability to reproduce in the future.

**Causes of Angelic Circumcision (Hypospadias)**

 

As with many congenital malformations, the main cause of the problem of angelic circumcision (hypospadias) is still unknown.

These congenital malformations begin to form during fetal development in the womb, especially between the ninth and twelfth week of pregnancy, when the penis is formed and male hormones begin to stimulate the body to develop the urethra and foreskin.

Therefore, the cause of many cases of hypospadias is attributed to a hormonal imbalance or a problem in the function of these hormones, which leads to the urethra growing abnormally.

There are also several factors that contribute to an increased risk of angelic circumcision in children, including:

Although angelic circumcision is not considered a genetic disorder in itself, having a family history of it, such as a father or brother, can increase the likelihood of it occurring.

The mother's use of fertility treatments, including hormonal treatments that contribute to pregnancy.

Premature birth.

Age of the mother; the chances of giving birth to a child with this condition increase.

The mother's weight gain can affect the birth of a child with angelic circumcision.

The mother's smoking or exposure to chemicals such as pesticides during pregnancy are also influential factors.

Also, the mother's diabetes before pregnancy is considered a factor that may affect the health of the child.

**Signs and symptoms of angelic circumcision (hypospadias)**

 

- The presence of the urethral opening (meatus) at the bottom of the penis instead of its normal location at the tip of the penis.

- Abnormal urine flow during urination, as older children may need to sit down while urinating in severe cases.

- Curvature or curvature of the penis, a condition known as (chordee).

- Abnormal appearance of the penis, especially as a result of the formation of an additional foreskin on the upper side only.

- In some cases, children with angelic circumcision may suffer from additional problems such as an undescended testicle or inguinal hernia.

Does the child need to see a doctor after the operation?

 

Yes, your child should visit the surgeon twice after the operation, in addition to regular follow-ups with the doctor who performed the operation. It is also important to train the child to use the toilet to ensure complete recovery and that there are no complications such as fistula (a hole that may occur in the lower part of the penis at the site of the operation) or problems with wound healing and scarring. Therefore, it is necessary to conduct a comprehensive examination of the child at birth and in early childhood, as delaying any treatment may expose the child to future risks.

How is hypospadias diagnosed?

 

This deformity is a common condition, occurring in about 1 in 200 births. Hypospadias may sometimes be associated with some defects in the urinary system such as inguinal hernia, undescended testicles, upper urinary tract defects, and urethral fistula. This deformity is usually discovered after the child is born while he is in the hospital, but if it is not diagnosed, the mother may later notice that her child has problems urinating and an abnormal urine flow. In this case, you consult a doctor who will discover the presence of hypospadias during a routine examination of the external genitalia.

What is the treatment for angelic circumcision and how is the urethra repaired? Does the treatment require medication or surgery?

 

First, it is necessary to avoid circumcision (circumcision) for a child suffering from hypospadias, as the surgery necessary to repair this condition later will require the foreskin tissue that is removed during circumcision. Some forms of hypospadias may be minor and do not require surgical intervention.

**Surgical treatment** The treatment of angelic circumcision involves performing surgery to reposition the urethral opening, so that it is returned to its normal location, and correcting the shaft of the penis if necessary. The urethral repair and angelic circumcision can be performed in one surgical procedureThis is done in an outpatient clinic. However, some cases may require more than one surgery, separated by a period of three to six months, to ensure that the deformity is completely corrected. When the urethral opening is close to the base of the penis, the surgeon may need to use tissue grafts from the foreskin or from inside the mouth to reconstruct the urethra appropriately. Performing a surgical procedure that aims to expand the urethral meatus to reach the head of the glans penis, giving the penis a natural appearance, as in the case of circumcision.

Closing the abnormal opening.

Doctors work to install a urinary catheter for the child to avoid contact with urine from the wound resulting from the operation. This catheter remains in place for 7 to 10 days after the child leaves the hospital, before it is removed.

**After the operation**

The child returns home with a bandage on his penis, and it is preferable to expose him to a warm water bath three or four times a day. The bandage is expected to fall off naturally during the bath. If this does not happen, it will be necessary to remove it, as it should be removed within 24 to 48 hours after surgery.

If you experience any difficulties in removing the bandage, you can contact the doctor. The child also needs to drink plenty of fluids after the urethral opening modification surgery, especially since he will be taking some medications that may cause constipation. It is important to avoid constipation because it may lead to pain.

Therefore, the child may need to use laxatives (such as glycerin suppositories) if he suffers from constipation. It is recommended to drink plenty of water and eat foods rich in fiber such as whole grain bread and fresh fruits.

When should you consult a doctor after the angelic circumcision of the infant?

 

After the hypospadias surgery, you should monitor your infant's condition. If the following symptoms appear, it is recommended to contact the doctor:

- Continuous crying of the infant.

- Increased pain due to the child's inability to urinate.

- High temperature of the child.

- Severe redness, inflammation and swelling.

- Continuous bleeding.

- Inflammation of the penis with the tip turning gray or blue.

- The plastic piece does not fall off after two weeks.

**Failure of the urethral correction surgery**

 

Urethral correction surgery is usually considered a successful surgery, but in some cases it may fail, which negatively affects the person physically and psychologically. Repairing these complications is a complex process, and often requires several operations gradually. Among the complications that may occur after the urethral correction surgery, we find the following:

**Formation of a urethral fistula** Urethral fistula is one of the most common complications after the urethral correction surgery, as the fistula can form months or even years after the operation. This occurs when an abnormal connection forms between the skin of the penis and the urethra, which leads to urine leakage through the fistula.

**Stenosis or blockage of the urethra** Urethral stricture is one of the most difficult complications associated with the urethral correction surgery, as scarring can occur leading to narrowing of the urethra, affecting urine flow. Urethral stricture can also affect other organs in the reproductive system, such as the kidneys, bladder, prostate, and testicles. Symptoms that may appear in a person with urethral stricture or obstruction include:

Weak urine flow.

Pain during urination.

Stretching while emptying the bladder.

**Penile curvature** Sometimes, the surgeon may not completely adjust the penile tendon, which leads to a curvature of the penis. Correcting the penile tendon is an essential step in correcting the urethra, as failure to do so during the operation may lead to failure of the urethra correction and complications.

**Diverticulum** Visible fluid-filled bulges can form in the urethra during urination. Diverticulums can lead to urinary tract infections and inflammation in the diverticulum area, in addition to feeling pain during urination.

**Shortened penis** Urethral correction surgery may affect the length of the penis, which may lead to shortening.

**Skin and tissue damage at the site of the procedure** Urethroplasty can cause partial or complete tearing and rupture of the skin of the glans.

**Epididymitis** Inflammation and swelling of the canal that connects the urethra to the testicles.

**Repeated hypospadias and epididymitis** This occurs when there is another urinary opening on the underside of the penis.