By Dr. P. Ashwin Shekar, Consultant Pediatric & Transitional Urologist, Asian Institute of Nephrology and Urology (AINU)
What is hypospadias?
Hypospadias is a birth defect where the opening of the urethra on a male baby's penis is located on the underside instead of at the tip. It occurs in approximately 1 of every 150 to 300 male infants. It is often associated with bending of the penis downwards called chordee in children which also needs to be addressed.
What causes this condition?
The exact cause is unknown, but genetics likely play a role, meaning it can sometimes run in families.
Is it a difficult condition to treat?
Hypospadias can vary in severity, with mild cases requiring less intervention and more severe cases needing more complex surgeries.
How is it diagnosed ?
It is usually identified at birth by a healthcare professional during a physical examination.
If my child is diagnosed with hypospadias what are the important points to be kept in mind?
Avoid Circumcision: Circumcision is usually not performed at birth for babies with hypospadias, as it may affect the surgical repair.
Check for undescended testes : If a child has associated undescended testes especially on both sides then evaluation for checking the sex of the child in the form of karyotyping needs to be done .
Emotional support: Parents should be prepared to address emotional concerns related to their child's condition and discuss any anxieties with their healthcare team.
When to see a doctor:
If you suspect your newborn son has hypospadias, contact your pediatrician or a pediatric urologist immediately.
What is the treatment for this problem?
Most cases require surgical repair to ensure normal urination and sexual function later in life and is typically performed by an experienced pediatric urologist. It is imperative that experience is crucial in managing this condition as an improperly done first surgery can have long-term adverse effects on the quality of life of these children. In fact, we have a term called hypospadias cripples for patients who have multiple failed attempts at repair.
When is the right time to intervene for this problem ?
Most boys with hypospadias will need surgery between 6 and 12 months old . However it also depends on the size of the penis as sometimes we need to delay surgery for better growth of the penis before surgery. In some older children testosterone supplementation may be needed prior to surgery to increase the size of the organ .
Having said that in India, unfortunately we still see adolescents and adults who come to us with the problem as they are undiagnosed at birth or the parents had failed to notice it.
Can you briefly elaborate on the surgery for this condition?
The surgery involves correction of the bend in the penis if present along with the repositioning the urethral opening to the tip of the penis
Depending on the severity, the procedure may be done in a single stage or in multiple stages
Following surgery what are the points that parents need to understand ?
In the immediate post-operative period, careful maintenance of dressing and catheter needs to be done .Any soakage of dressing or blockage of catheter needs to be brought to the attention of the surgeon Follow-up appointments with the urologist are crucial
How long follow-up is needed for children who are operated for hypospadias ?
All children with hypospadias need to be followed up till puberty or longer as the chance of complications increase with duration of follow up.
What are the signs of urinary problems to watch out for in the long term ?
Some of the signs are straining to void, thinning of stream, ballooning of urethral tube deviation of stream development of recurrent bending of penis which may need to be addressed surgically .
What other issues that may need to be addressed in children as they grow up into adulthood?
Children with proximal hypospadias can have psychosexual and fertility issues as they grow up due to factors like a small penis especially when they have been operated multiples times and have associated anomalies.
If a child with hypospadias operated in childhood develops problems in adolescence or adulthood whom should you approach ?
Ideally these children need to be managed by transitional urologists who are adult urologists trained in managing paediatric urological anomalies and are well versed with managing this complex condition in both children and adults. This is an upcoming field of urology which has started gaining traction in the west, which bridges the gap between paediatric and adult urology care as many of these children need lifelong care. We at AINU are in the process of developing a center of excellence for transitional care in the country which is a first if its kind in India to make sure our Indian children with complex anomalies get continuity of care all through their life, like their western counterparts.