What is Hypospadias in Children?

Hypospadias is a condition of the penis. It affects about one in 150 male babies and is usually detected at birth.

The urethra is a tube connecting the bladder to the tip of the penis, carrying wee out of the body. In hypospadias, the end of this tube does not form properly and the wee comes out in the wrong place.

In most cases, the foreskin is also undescended and an abnormal curvature of the penis may be present. This can affect self-esteem and future sexual function.

Unless very minor, hypospadias usually require surgery.

What are the types of hypospadias?

Healthcare providers classify the type of hypospadias based on where the urethra opens:

Glanular (balanic): Here, the meatus or urethral opening will be present at the head of the penis but not at the complete tip. It is the mildest form of hypospadias.
CoronalThis is the most common form of hypospadias. The meatus will be below the head of the penis or at the junction where the head connects the shaft.
MidshaftMidshaft hypospadias occurs halfway along the shaft of the penis.
PenoscrotalPenoscrotal hypospadias occurs at the junction between the penis and scrotum.
Scrotal/Perineal: Scrotal and perineal hypospadias are the most serious forms of hypospadias. The urethra opens within or below the scrotum.

Who gets hypospadias?

Some conditions in the birth mother (mother) may increase the risk that a baby has hypospadias. These include:

A body mass index of 30 or more (has obesity).
Advanced maternal age: Pregnancy at an age over 35 years.
Other hormones taken before or during pregnancy.
Pesticide or chemical exposure.
Smoking during pregnancy.
Fertility treatment to conceive a baby. This could be because progesterone is used.
Progesterone is a hormone prescribed by healthcare providers when undergoing fertility treatments to maintain early pregnancy.

What are the symptoms of hypospadias?

Hypospadias is mainly characterized by an abnormal condition in which the meatus is not located at the tip of the penis. Other symptoms of hypospadias may include:

The foreskin can be all at the top of the penis (dorsal hood) and there may be none at the under surface.
There is not a straight stream of urine.
The meatus of the urethra, which is the location of urine flow, does not occur at the very end of the penis but somewhere in the middle.
The penis may not be straight (it has a bend in it) – this is known as a chordee.

What causes hypospadias?

The causes of hypospadias are unknown to healthcare providers and medical researchers. Exposure to certain chemicals may be linked to a heightened risk of hypospadias in a child. There is a potential for a genetic cause. The risk is increased for a baby born with hypospadias if a biological relative is a male who was assigned male at birth (for example, father or brother) and had hypospadias.

Hypospadias can also present with infants' AMAB without any other birth defect. However, it is mostly presented with other congenital defects and birth defects.

Hypospadias is formed during early gestation. The development of the penis begins during the eighth week of gestation. Hypospadias occurs between the ninth and twelfth weeks of gestation.

How is hypospadias diagnosed?

Hypospadias is easily diagnosed as the meatus is not found at the tip of the penis. It often doesn't form fully or cover the underside of the penis as it would during normal development. In some cases, the abnormal foreskin can resemble a "hood" hanging on the back of the penis. The penis may also have some downward curve or bend to it. In more severe forms, it may be a very small or short penis and an appreciably divided scrotum.

Usually, healthcare providers make a diagnosis of hypospadias shortly after birth.

Examination for hypospadias is included in the routine newborn physical examination which a pediatrician conducts. Sometimes, the providers do not detect hypospadias until they attempt to circumcise the baby. If your healthcare provider diagnoses hypospadias, they will not proceed with circumcision.

What is the treatment of hypospadias?

Hypospadias can be treated with surgery: hypospadias repair. Most pediatric urologists would do a hypospadias repair when the child is between 6 and 12 months of age. This is because postoperative care for the surgery site will be very simple to do at this age. Also, the risk of anesthesia is lower in this age.

Hypospadias surgery is often an outpatient procedure- meaning your baby goes home the same day and is completed in several hours in some cases. For serious forms of hypospadias, healthcare providers must perform the surgery in stages.

In hypospadias repair, a pediatric urologist will straighten your penis, so that everything fits correctly. He will also reconstruct the urethra to complete the "tube." This will create a urethral opening near the tip of the penis.

Reattach the remainder of penis skin and a circumcision, though rarely. Sometimes, a provider will place an installation of a temporary Foley catheter and allow it to stay while the urethra and penis heal. A provider will remove the catheter at a follow-up appointment, usually one to two weeks after the surgery.

All surgery carries with it a number of risks and potential complications. These are rare, however, and the benefits of surgery far outweigh any risks. Some complications particular to hypospadias surgery include the following:

Most children need a catheter or stent for about a week after surgery.
Some catheters sometimes have a side effect of bladder spasms.
Medication is available to help stop the spasms if they occur.

What are the risks or side effects of hypospadias repair?

As with all surgery, there are some risks and potential side effects involved. These are rare, and the benefits of surgery will outweigh the risks. Specific complications related to hypospadias surgery are as follows:

There may be some bleeding from the penis.
The new opening may narrow, which makes it harder to pass urine. This is known as a stricture.
The wound may not heal properly. Either half or very rarely both halves, of the wound could break down. Urine may leak out of the original hole. This is called a fistula.
There may be incomplete correction of the bend.
Most children need a stent or catheter for about a week after the surgery. Bladder spasms are an adverse effect from some catheters. Medication to stop the spasms is available if they occur.
Only a seasoned pediatric urologist, a physician who specializes in the urinary tract systems, can perform surgery for hypospadias.

Can hypospadias be prevented?

Pregnant people can lower their babies' risk of having hypospadias by:

Taking folic acid (about 400 to 800 micrograms daily).
Getting regular check-ups with a healthcare provider.
Not smoking or drinking alcohol.

What should I expect if my child has hypospadias?

Hypospadias has an excellent prognosis. Hypospadias repair is often successful. Surgery that is successful tries to make the penis look and behave like a normal one.

When to see a doctor?

Follow up appointments as advised by your child's doctor. Your child's penis should heal nicely. It will be necessary to have further operations if your child's hypospadias is severe.

Why Choose Tender Palm Super Speciality Hospital for Hypospadias Treatment in Children in Lucknow, India?

Tender Palm Super-Speciality Hospital has the most trusted team of Pediatric Urologists with advanced diagnostic equipment and child-friendly care for Pediatric Hypospadias Treatment in Lucknow, India. Our Pediatric Urology department follows international safety standards and has years of experience in successfully managing children's Urological diseases.