What is hypospadias and how can it impact your child?

The situation can be distressing if as soon as you hold your little buddy for the first time, and then the doctor tells you that your baby has “hypospadias”. You cannot even fathom what trouble has this word brought. However, hypospadias is a lot more frequent condition than most parents think it is and one that has a treatment. So, then what is hypospadias and how scary is it? It is when the urethral opening where they pass urine is not at the tip of the penis but on the underside. With that being said, it is not a worry as the baby will do just fine with medical support and with the help of proper medical care.

The National Institute of Health has pointed out Hypospadias to be among the most frequent congenital conditions experienced by boys affecting somewhere between 1 out of every 200 – 300 boys born alive. Additionally, it’s occurrence may depend on genetic factors, maternal age and or environmental exposure in pregnancy. Hypospadias is usually noticeable at birth during the newborn’s physical examination, and a paediatrician can diagnose it easily. For these reasons, surgical correction is highly recommended during infancy to restore both the function and appearance of the penis.

What does hypospadias look like?Other signs pointing to hypospadias are:

• Downward curve of the penis (chordee): During erection, the penis hangs in a curve or down sloping.
• Abnormal foreskin: Foreskin fails to cover the underside fully, leaving the upper skin looking like a hood on the penis.
• Spraying urine stream: The misplaced opening can cause an irregular or spray-like urine stream.
• Fertility issues: In rare and severe cases, untreated hypospadias may impair reproductive function.

The role of surgery in correcting hypospadiasSurgery can treat hypospadias and this involves surgical procedure that moves the urethral opening to the tip of the penis, corrects any curvature, and reconstructs the foreskin if needed. The best specialist to perform this procedure is a paediatric surgeon who specializes in urological and congenital conditions in children.

When is the right time for surgery?Pediatric surgeons typically recommend correcting hypospadias between 6 and 18 months of age. Performing the surgery during this window ensures the following benefits:

• The penis is large enough to enable effective reconstruction.
• Babies heal faster during infancy due to their young age.
• Performing surgery early minimizes emotional stress for the child and family.

While some parents wonder whether it is better to wait until the child reaches toddlerhood, delaying the surgery is generally not recommended unless medical concerns require postponement.

The complexity of hypospadias surgery depends on the severity of the condition. Mild cases can often be corrected in a single surgery, which typically takes 1 to 2 hours under general anesthesia. Severe cases may require multiple surgical stages.

The reconstruction surgery of the urethra is performed for the treatment of hypospadias and is obtained from the penis foreskin or other areas of the penis. The aim is to provide a stable urethral opening so that the penis appears and functions normally. Pediatric surgeons perform the operations with great attention to detail so that the outcome is desirable with few side effects.

Hypospadias is a common condition that can be easily and effectively solved with a surgery. A precise and effective supporting treatment such as a routine follow up evaluation of the child should hopefully alleviate any concerns for the child and his family. Children are difficult to follow as they grow up and are also scared of surgery so one has to be gentle but directive during the settings where parents usually need extensive guidance to feel confident.

Staying informed and getting prepared beforehand, both physically and emotionally, can help parents withstand this change with their child. All in all, children do tend to move ahead, leading a wholesome and productive life without any additional complications.

Dr. Manjiri Somashekhar, Lead & Senior Consultant - Paediatric Surgery, Aster Women & Children Hospital, Bengaluru