What is hypospadias repair?
Hypospadias is a condition present at birth in which the opening (meatus) of the urethra lies somewhere along the underside of the penis instead of at the tip. Curvature of the penis (chordee) hypospadias and an abnormality of the scrotum (penoscrotal transposition) may also be present to varying degrees.
Surgery is typically recommended between the first 6 months to 2 years after birth. The goals of the surgery are to:
- Build a new urethra (the tube inside the penis that carries urine and semen)
- Straighten the penis
- Build a new opening at the tip of the penis.
Hypospadias repairs can require follow-up surgeries, sometimes fairly soon after the first one and at other times many years or decades later.
What are the categories of hypospadias repair ?
The categories of hypospadias repair are as follows:
- Orthoplasty: Straightening of the penis
- Urethroplasty: Rebuilding the urethra so that urine and semen will flow as far forward as possible
- Meatoplasty/glanuloplasty: Building a new opening and reconstructing the head of the penis as necessary to accommodate the new opening
- Scrotoplasty: Repair of the scrotum
- Skin coverage: Getting enough skin grafts to complete all necessary hypospadias repairs
The form of treatment used will depend on the individual conditions of the patient. There are currently more than 200 known procedures for fixing hypospadias. After puberty, repair is made in two stages that are spaced 4 to 6 months apart. Most commonly, the skin in the mouth is used for the repair.
Risks / Benefits
What complications can occur after hypospadias repair?
Some of the more common complications after a repair are:
- A breaking down of wounds during the healing period: the repair “falls apart” or the skin graft fails to “take”
- Narrowing of the opening
- Urethrocutaneous fistula: A hole in the skin of the penis that is deep enough to reach the urethra and allow urine to leak through; it is possible for a fistula to form months or years after hypospadias repair
- Urethral stricture: Local scarring that narrows the urethra, restricting the flow of urine; results in pressure on surrounding structures such as the kidneys, prostate, bladder, and testicles
- Hair in the urethra: a result of using hair-containing skin for repairs; the use of such skin is avoided in more modern surgical techniques
- Stones in the urethra
- Epididymitis: Swelling in the channel leading from the testicles to the urethra
- Diverticulum: A bulge in the urethra that forms a fluid-filled pouch
- Shortening of the penis
- Recurrent curvature of the penis
What are some symptoms of hypospadias repair complications?
- Weak urinary stream or pain when urinating
- Pain in a testicle, either side of the body, or the lower back
- Straining to empty the bladder
- Lumps or hard spots in the penis
- Discomfort during sex
- Urinary tract infections
How are complications of hypospadias repair diagnosed?
The doctor will take a complete medical history and will do a physical exam. Special areas of concern are the presence of fistulas, urinary problems, blood in the urine, and urinary tract infections. Also, the doctor will:
- Review reports (if available) related to previous repairs
- Locate the opening in the penis before repair
- Ask about the urine flow’s strength, direction, and any spraying or leaking
- Determine how much curving there is when the penis is erect
- Possibly perform a cystoscopy or imaging study known as a urethrogram to find any blockage that is present
What causes complications of hypospadias repair?
- Poor blood supply
- Buildup of scar tissue
- Breakdown of tissue (from areas such as the inner arm, thigh, bladder or foreskin of the penis) used in hypospadias repair
- Failure of reconstructed tissue and original tissue to completely join together properly
Recovery and Outlook
What is the long-term outlook for repairs of hypospadias complications?
- In one report that examined 1,176 patients, men needed an average of three surgeries to repair primary hypospadias. Nearly 10% of patients required five or more operations. Patients need to be prepared and committed to the possibility that multi-stage surgeries will be needed to reach a desired result.
- Scarring of the skin of the penis can result in loss of or a change in sensation. At times, extensive scarring from multiple procedures requires removal of all scar tissue and beginning with fresh grafts. Scarring can be very psychologically upsetting to the patient. It has a negative impact on the cosmetic appearance of the penis. It may also contribute to functional problems related to erections and intercourse.
It is important for the patient and doctor to have an open line of communication. The patient should voice what his expectations for final results are. The doctor should be ready to discuss the realities of what can actually be accomplished given the situation presented.
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