Hypospadias

What is hypospadias?

Hypospadias is the term used to describe a congenital abnormality of the urethra of persons with a penis. The urethra does not end at the tip of the glans like in healthy individuals, but instead opens along the underside of the penis shaft. The opening of the urethra can also be displaced to the testicles, depending on its severity. Hypospadias is also usually accompanied by an altered penile curvature during an erection and a split foreskin. The first visible signs of hypospadias in newborns are often the visible split foreskin and a weak urine stream. If there is any suspicion, it is recommended to perform a chromosome examination on the child. This may reveal possible additional genetic changes and enables the treatment plan to be adapted at an early stage if necessary.

How do urethral malformations develop?

A urethral malformation like hypospadias usually arises during embryonic development in the womb. Normal development of the urethra and the surrounding genitals involves fusion of the various embryonic tissues from around the 9th week of pregnancy. These tissues are called genital or urethral folds and, with hypospadias, they do not or only partially fuse together. Epispadias is another form of urethral malformation and is characterized by the opening of the urethra being above the expected position.

When should hypospadias be treated with surgery?

Hypospadias is not a medical emergency in most cases and does not need to be operated on right after birth. Nonetheless, surgery remains the only treatment method and is recommended from the age of 6 to 15 months to prevent later complications such as incontinence, impotence or further limitations in sexual behavior. The precise timing of an operation is determined on an individual basis and depends on the extent of the deformity and the stage of development of the affected child. It is also possible to operate on a hypospadias later in life and into adulthood.

Procedure for hypospadias surgery

Depending on the severity of the hypospadias, the precise methods used during surgery vary. The goals are nonetheless the same for every operation. During the procedure, the urethral opening is relocated to the tip of the glans and other openings along the shaft are closed. The incorrect curvature of the penis is also corrected. As part of the aesthetic adjustment, the foreskin flap is also corrected or removed. Sometimes patients also suffer from malrotation of the penis shaft, and this is can also be repaired during surgery. According to the extent of the correction required, hypospadias can be repaired with a single operation or several operations. One of the most common complications of surgery is fistula formation. This describes an abnormal connection between the bladder and other organs, such as the bowel, or an extra opening in the urethra. Most people with hypospadias have this additional opening around the former opening, which was supposed to be closed during the operation. Other complications include infections, bleeding and swelling.

Long-term complications of hypospadias

Untreated hypospadias virtually always leads to aesthetic problems, which can negatively affect the self-confidence of the patient. In addition, depending on the severity of the malformation, incontinence or impotence may also occur. The altered penile curvature often also results in painful erections, which can be extremely limiting for the affected person's sex life.

Which doctors and clinics specialize in hypospadias surgery?

Hypospadias surgery is usually performed by a team of specialists. They consist of specialists in pediatric urology and pediatric surgery. The initial admission and inpatient treatment is carried out by pediatric urology - the specialty for diseases of the urinary tract and kidneys - while the operation itself is performed by surgeons. This interdisciplinary approach makes it possible to provide individualized treatment that covers all needs and difficulties.
If you're in need of a doctor, you expect the best medical care possible. So of course patients are curious to find out what clinic to go to. As there is no objective way to answer this question and a legitimate doctor would never claim to be the best, patients must rely on a doctor's experience.

Let us help you find an expert for your condition. All listed doctors and clinics have been reviewed by us for their outstanding specialization in the field of hypospadias and are looking forward to your inquiry or wish for treatment.

Sources:

• next.amboss.com/de/article/Mi0MHf

• www.uniklinikum-dresden.de/de/das-klinikum/kliniken-polikliniken-institute/kch/behandlungsspektrum/kinderurologie/hypospadie&;

• Smith & Tanagho's General Urology, 19th edition - Jack W. McAninch, Tom F. Lue