Hypospadias might be the most common congenital malformation in human males, but is still a reason for stigma and leads to as a motive for embarrassment and isolation.
Hypospadias can affect the physical as well as psychological upbringing of a male patient.
What is Hypospadias?
The male penis consists of the urethra that connects the bladder to the outside of the penis in the form of a tip known as the meatus.
In 1 out of 250 male infants, this urethral opening undergoes congenital malformations during pregnancy, and thus, is found on the ventral aspect or underside of the penis known as hypospadias. As the urethral meatus is on the underside of the penis, it can be situated close to the glans as well as near the scrotum.
Types of Hypospadias
1. Subcoronal (Mild) Hypospadias
It might be found near the head or glans of the penis. As a result, the symptoms are too mild to notice and don’t interfere with excretion or reproduction later on.
2. Mid-shaft (Mild-Moderate) Hypospadias
The urethral opening is found midway throughout the entire length of the penis, that is, along the penile shaft.
Usually, mid-shaft hypospadias might occur in association with strictures along the urethra, which also affect the urinary stream and give rise to dribbling or incontinence after voiding. Mid-shaft hypospadias might require your child to sit down while urinating so that the flow of urine doesn’t spray everywhere during the process.
3. Penoscrotal Hypospadias
In this type, the urethral opening is situated further from the tip of the penis and opens just beneath the scrotum at the penoscrotal junction. Right before a child is born, the testes descend into the scrotum from the abdominal cavity to adjust its temperature to achieve puberty after childhood. But, most severe cases of penoscrotal hypospadias occur in association with undescended testes, and thus, lead to infertility or the failure to reproduce when the child is of mature age.
Signs and Symptoms – Is Hypospadias Severe?
Depending on the location of the tip of the urethra, the symptoms of hypospadias might be mild, moderate, or severe as discussed above. The severity of these symptoms helps to determine whether the male requires hypospadias repair during his childhood or can wait till he is of mature age.
At times, hypospadias might go undiagnosed, mainly because its symptoms are too negligible for the male infant or his family to notice.
Usually, the male infant might undergo the following signs and symptoms since childhood:
1. Poor Urinary Flow
Stream of urine that is directed downwards or sprays in different directions. At times, asymptomatic hypospadias might occur in association with meatal stenosis, where the original tip at the glans penis undergoes abnormal narrowing.
Due to the narrowed tip, the male infant might urinate only from the hypospadias, resulting in dribbling, thin or double stream of urine. At times, urinary leakage might occur from both the urethral openings, leading to discomfort and inadvertent incontinence.
2. Painful Erection
Cases in which hypospadias is found near the scrotum are considered to be quite severe and might warrant immediate hypospadias repair to prevent further complications. Complications might arise as the male infant grows up and acquires puberty. He can suffer from pain during erection due to an abnormally bent curvature of the penis, chordee, which most likely occurs with uncorrected cases of hypospadias. Chordee can also lead to discomfort during intercourse and might impede sexual activity.
3. Underdeveloped foreskin
Every male infant is born with an extra layer or sheath of skin that covers the head or tip of the penis, also known as glans. Many families might opt for the circumcision of the foreskin, either due to religious or health concerns, as it might lead to inflammation and infection when the child is of reproductive age.
In patients with hypospadias, the foreskin is underdeveloped and thus, only covers a fraction or half of the head of the penis, leaving the rest exposed.
It is natural to feel ‘scared’ before consulting a pediatric urologist. You might have your concerns related to the surgical repair of hypospadias, but it’s better to welcome them with an open mind. Each matter is essential and helps to signify the child’s quality of life as he grows up.
While discomfort during micturition is a pivotal reason to consult a healthcare provider, most parents are concerned about their child’s sexual prowess that is when he grows up.
Your healthcare provider might recommend you to consider getting a hypospadias repair correctional surgery for your child during 6 – 18 months of age. Usually, the pediatric urologist will tell you to postpone your child’s circumcision till after hypospadias repair, as the foreskin might be used during the surgery.
At times, the male infant or child might need to undergo a couple or series of procedures as per the severity of hypospadias. For instance, patients suffering from penoscrotal hypospadias might undergo a couple of methods to correct the urethral opening as well as the case of undescended testes (cryptorchidism) with orchiopexy.
Most doctors identify hypospadias in male infants during a physical examination that is conducted right after the child is born. Some might go unnoticed, and are, however, observed when the parents decide to go for circumcision (removal of the foreskin) of the male penis.
Many parents notice the way their child sits down and avoids standing up during voiding of urine. Plus, whenever the child voids, the parents might also observe a double or thin stream of urine along with hesitancy, straining, and difficulty to empty the bladder.
Things to Consider When Opting for Hypospadias Repair Surgery
- Always remember to opt for a pediatric surgeon who excels in correcting urinary tract systems and genitalia (urologist) in male children.
- Considering surgical repair for your child at such a young age is a controversy. But, hypospadias repair isn’t a lengthy surgery and doesn’t require an overnight stay for your child as well.
- Your child might be placed under general anesthesia so that he is numb to the pain experienced during surgery. Your child will also be placed on a catheter per urethra for a minimum of 2 weeks so that the corrected urethra manages to stay in its place.
Complications and Side Effects
- The corrected urethral opening might undergo narrowing and give rise to the formation of stricture after hypospadias repair. A stricture in the urethra will give rise to difficulty and hesitancy during micturition along with a thin or double stream of urine.
- Other side effects include the formation of a fistula, that is, abnormal conjunction of two surrounding body structures. In the cases of hypospadias repair, the wound might not heal properly and give rise to a urethrocutaneous fistula by connecting its hole with that of the surrounding skin. Urinary leakage through the urethrocutaneous fistula can occur at all times and give rise to discomfort and wetting of clothes.
Every pediatric urologist needs to counsel the family of the male infant regarding the prevalence of hypospadias and how it might affect further offsprings in the family. Educating and creating awareness regarding hypospadias is a primary step without which we believe, doctors cannot get rid of the stigma that’s crippling our male youth.