Hypospadias Surgery Best & Affordable
Hypospadias Surgery is done on those who has it as a birth defect in baby boy in which the penis neither works well nor looks normal. It is the defect of the urethra in the male where the urinary opening is not at the usual location on the head of the penis. It is the second most common birth abnormality in boys, affecting approximately 1 of every 250 new born boys.
The urethra normally travels in the male through the full length of the penis so that the stream of urine comes from the urethral opening at the tip of the penis. However, in hypospadias the urethra does not go all the way through the penis but, instead, opens on the underside of the shaft of the penis or below the penis hence the urine comes from an opening that is on the underside of the penis or below the penis.
Causes: The exact reason of this defect is unknown. Sometimes hypospadias is genetic.
Symptoms of Hypospadias:
- Opening of the urethra at a location other than the tip of the penis
- Abnormal spraying during urination
- Downward curve of the penis (chordee)
- Hooded appearance of the penis as only the top half of the penis is covered by foreskin
Association with Psycho-social aspect on Hypospadias
Hypospadias if untreated influence a man’s psycho-social status. Affected man often feels like he has got this horrible secret in his pants and if others will find out, they would make fun of him. Hypospadias leads to shame and aloneness that a guy can feel when he’s growing up. One of the reasons for feeling so different is because he needs to sit down to pee unlike other males.
Need for the Hypospadias Surgery
Parents usually ask the Urologist that their child urinates finely and has bowel movements just fine. So why are we having the surgery done if it doesn’t hurt him and he urinates just fine? Simple answer to these parents is Surgery is essential because Hypospadias can cause problems as he gets older. Problems are listed below: 1. Irregular urine stream .He would have to pee sitting down his whole life. 2. His penis would look different than other boys. 3. It could potentially create fertility issues. The opening of the penis is not close to the cervix as a result of which the sperm is not in the right place to cause pregnancy. 4. If the penis has chordee (downward curvature of the penis) it becomes very painful, difficult or even impossible to have intercourse as an adult.
If the hypospadias needs to be repaired, this is done by surgery. The aim is to repair and reconstruct the urethra. Depending on the degree of the hypospadias, the surgery can range from relatively simple to very challenging. It is usually performed by the paediatric urologist when the baby is between 6 to 15 months old. General anaesthesia is used to keep the baby asleep during surgery and additional medications provide post-operative pain relief.
I would like parents who have a son born with hypospadias to be reassured that the anatomy can be reconstructed, the surgery is safe and well tolerated, and a good outcome with a normal or near normal, penis appearance and function can be achieved.
As a Urologist, I owe it to our team for excellent results and patient happiness. For parents It is not easy to get their young child in Operation theatre. I really wish to express my gratitude to the parents and families who give their little ones in our hands trusting us to do the right thing for their child.
Post- surgical complications
Pain: Most of the time the babies are slightly cranky but manageable. Analgesic (pain-killer) syrup is prescribed to help in pain relief.
Spasms: Babies may have intermittent spasms due to irritation by the catheter. For this reason a small dose of bladder relaxant is usually prescribed.
Blood spotting in the diaper/ catheter may occur in the first few days. A few drops of the blood are acceptable. In case of continuing ooze, a hospital visit may be required, but this is very infrequent.
Dressing issues: Dressing loosening up may occur in some babies. If it happens during first 2-3 days, then a new dressing is placed. After that, the dressing is just removed.
Infection may happen and is the most common cause of the failure of surgery. To prevent this, broad spectrum antibiotic syrup is usually prescribed for 7-10 days. It is vital to prevent stool smearing up the dressing in immediate post-operative period.
Fistula: Fistula is a small area of breakdown in the operated area, leading to sideways leakage of urine. Fistulas may heal in due course of time.
Stenosis/ Stricture: During healing period, the new urinary tube may become tight. Mostly this happens at the tip of penis and can be easily managed by daily calibration at home with a small feeding tube.
These complications are typically 5% if the surgery is performed by an experienced Urologist.
Adult hypospadias/ Re-do hypospadias Surgery
Most cases of adult hypospadias are those who live with hypospadias all their life. They know they are different, but they suffer with it because of their misbelief that there was nothing to be done about it when they were infants. But as they grow old, it causes a lot of anxiety growing up, and into adulthood. It has nothing to do with fathering a child although usually it is near to difficult.
As far as I have practiced I have realized that the adult patient with hypospadias ignores the disease as he is already into middle age now. He had his children. But such patients should be educated about connecting adult hypospadias with chronic prostatitis and urinary tract infections, painful intercourse, abnormal look of penis. I would recommend not suffering needlessly with a regret that you went through your life ignorant to options. This is absolutely treatable disorder. You can have a normal penis. You can pee normally and not spray all over the place. You can have pain free sex.
Hypospadias surgery in adults- Differences from surgery in children:
Longer healing time than children: comparable to hypospadias repair in children, the healing of penis in adults takes longer time. Though one can start passing urine normally in 2-3 weeks, it may take upto 2-3 months for the penis skin to heal fully.
Longer time for indwelling urine catheter: Catheter is kept inside for 10-14 days for distal hypospadias repair in adults and 14-21 days for severe hypospadias repair in adults which is quite more with respect to children where most of the catheters are removed in 5-10 days.
Higher risk of infections: The chances of skin infections at hypospadias surgery site is higher in adults as there is hair growth in penile area and more sweating in adults.
Pain after surgery: There may be episodes of severe pain during healing phase in first one month as adults have night time erections during a certain phase of the sleep.
Abstinence from sex: It is advisable to refrain from sex and masturbation for almost 3 months after hypospadias surgery in adults.
Off from work: Since most of the adults are in a job or business, it is important to take atleast 4 weeks off from work before planning hypospadias surgery.
Uroflowmetery: It is recommended to undergo a test called uroflowmetry to check the speed of urine passage at 3 months and one year of surgery to make sure that the new passage is of good caliber.
Hypospadias cripples :. In some cases even after hypospadias repair some functional complications prevail in patient that condition is termed as ‘hypospadias cripples’.
This condition is a challenge to reconstructive surgeons because of the complexity of the problem and limited options for reconstruction.
These patients have usually undergone multiple urethral surgeries leaving the blood supply compromised and healthy tissue scarce. While the repairs are technically challenging, these patients often also have physical and psychosocial issues.
The repair of hypospadias cripples is of particular concern to the reconstructive urologist. Given the variability involved in Re-do hypospadias repair, the reconstructive urologist should be familiar with several techniques. A number of surgical techniques are available for Re-do hypospadias repairs. Re-operative hypospadias repair is fraught with challenges given the intraoperative complexity and long-term risk of complications.
Hypospadias Surgery Result
Currently, more than 90% of the children with penile hypospadias get successful results after single stage hypospadias surgery and children are able to stand and pee like a normal kid a few days after surgery.
During hypospadias surgery, we usually take some tissue from extra foreskin on top and use the rest of it to provide equal skin cover on all sides to penis. Hence, after Hypospadias surgery, the penis has a circumcised appearance. Also, if there has been any bend in penis, that is corrected leading to straight penis after hypospadias repair. So in nutshell, in most of the cases a few weeks after surgery, penis looks like just that a circumcision has been done.
Generally with current hypospadias surgery techniques preserving nerve and blood supply, the hypospadias repairs have resulted in very good outcomes both from cosmetic and functional perspective. Some children who have undergone a flap procedure for a severe hypospadias such as for scrotal hypospadias may need an evaluation as the force of semen ejaculation may not be very good. Also a check-up is mandatory later on after puberty at about 13-24 years of age and after 2-3 years of sexual life/ marriage to ensure that the urethra is functioning well.
Dr. Gautam Banga at
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