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Paediatric hypospadias

OVERVIEW

Hypospadias is a condition present at birth in which the urethral opening is not seen at the tip of the penis but instead on the underside of the penis. This condition occurs during foetal development when the urethral tube, which carries urine from the bladder to the outside of the body, does not fully close during development.

The severity of hypospadias can vary from a mild case, where the opening is located near the tip of the penis, to a more severe case, where the opening is located at the base of the penis or even behind the scrotum. In addition to affecting the appearance of the penis, hypospadias can also affect the normal function of the urinary system and sexual function.

Symptoms of hypospadias

The main characteristic of hypospadias is the abnormal positioning of the urethral opening on the underside of the penis rather than at the tip. Other symptoms can include the following:

Abnormal curvature of the penis: In some cases, hypospadias can cause the penis to curve downward, a condition known as chordee.
Difficulty with urination: Depending on the location of the urethral opening, a child with hypospadias may experience difficulty with urination, including spraying or dribbling.
Incomplete emptying of the bladder: In some cases, hypospadias can cause the urine to flow back into the bladder, leading to a condition known as vesicoureteral reflux.
Abnormalities of the foreskin: The foreskin may be abnormally tight or may not fully cover the glans. It's essential to note that symptoms of hypospadias can vary, and not all boys with this condition will exhibit all of them, while some may not have any symptoms at all. If you suspect that your child may have hypospadias, it's crucial to consult a healthcare provider for an accurate diagnosis and suitable treatment..

Treatment

The treatment of hypospadias usually involves surgery to reposition the urethral opening to the tip of the penis and repair any other associated abnormalities. The timing of the surgery will depend on the severity of the condition, the age of the child, and the preferences of the parents and healthcare providers.

Surgery for hypospadias typically involves the following steps:

General anaesthesia: The child will be put to sleep using general anaesthesia so that they will not feel any pain during the procedure.
Incision: The surgical procedure involves making an opening on the underside of the penis to gain access to the urethra and the surrounding tissues.
Repositioning of the urethral opening: The surgeon will then reposition the urethral opening to the tip of the penis and use tissue from the foreskin or other parts of the body to create a new tube for the urethra.
Closure: The incision will be closed with dissolvable stitches or surgical glue.

Following the surgery, the child may require hospitalisation for a few days for monitoring and will need to have a catheter inserted to aid in draining urine from the bladder. In certain circumstances, further surgeries may be necessary to correct any residual abnormalities or enhance the appearance of the penis.

It's important to follow the healthcare provider's instructions for post-operative care, including proper cleaning of the surgical site, pain management, and restriction of activities to allow for proper healing. With proper treatment, most children with hypospadias can go on to have normal urinary functions.

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Dr Mangray, the founder of KZN Specialised Paediatric Surgical Service, and his associates, Dr Ngobese, Dr Govender and Dr Dube-Zvirikuzhe, have a well-established reputation for caring for children right until late adolescence.

FREQUENTLY ASKED QUESTIONS

FAQ

1Are there any long-term effects of hypospadias?

In some cases, untreated hypospadias can lead to long-term complications such as urinary tract infections, urinary incontinence, and sexual dysfunction, although these complications are relatively rare with proper treatment.

2Can hypospadias be treated without surgery?

In most cases, surgery is the only effective treatment for hypospadias, although the severity of the condition can vary, and some cases may not require surgical intervention.

3What are the potential complications of hypospadias surgery?

Complications of hypospadias surgery can include fistulae (small holes that leak urine later on), strictures (narrowing of the new tube), bleeding, infection and scarring.