Hypospadias

DEFINITION

Hypospadias is a condition that boys may be born with, where the penis has an incomplete or ‘hooded’ foreskin, a bend in the shaft (chordee) and the urethral opening is displaced on the underside of the penis to varying degrees. Hypospadias can range from mild to severe, and is relatively common, affecting 1 in 300 boys, and becoming more common over recent times.

It is usually an isolated condition, and decision making about how to fix it is not an emergency. The most important aspect of your childs immediate care is to avoid circumcision prior to surgery as the foreskin is used in reconstruction.

GOALS OF CARE

The penis should be ‘straight enough’ during erections when your son is older. 

The urethra should open ‘near enough’ to the tip of the penis.

The urinary stream should point forward and not be excessively splayed, deflected, or narrowed.

The appearance of the penis should be as conventional as possible, but minor differences are unlikely to cause significant distress as there is a wide range of what constitutes ‘normal anatomy.’

OUTCOMES

The rate of minor complications in hypospadias surgery is high. 20-30% of patients require an additional unplanned procedure. 

Proximal hypospadias is characterised by a significantly curved shaft and a urethral opening that is very low on the penis. These patients require more than one operation for complete reconstruction, are more likely to have complications and multiple additional procedures throughout their lifetime, and there is no consensus on the best way to approach this version of the condition.

One of the most important predictors of a satisfactory outcome is complete correction of the curvature of the shaft.

OUR APPROACH

During his overseas speciality fellowship in 2024, Dr Rob was trained to perform a novel 3 stage “Straighten and Close” technique. This is a novel and relatively new technique, which has excellent outcomes is being utilised in just a few world leading paediatric urology specialist centres. One of the key differences to other approaches, is that the penis is lengthened to straighten, rather than ‘plicating’ or shortening. This is associated with a longer urethral reconstruction, and is anticipated to result in a longer phallus overall. At the time of writing, Dr Rob is the only Paediatric Urologist in Australia who is trained in this technique.

POST OPERATIVE RECOVERY AND CARE

Hypospadias surgery is a day case procedure which takes between 60 and 180 minutes. Your child will be discharged from hospital the same day. Most patients will have a catheter which drips in to the nappy, and a bulky dressing over the penis. For some minor procedures, a catheter and dressing may not be needed at all.

While your child has a catheter, they will be given antibiotics and analgesics. They will be seen at hospital or in the clinic 1 week later to have the dressing and catheter removed. They will then commence daily salt baths until the surgical wounds are looking clean and dry.

If your child needs a 3 stage procedure, then each stage will be performed at least 6 months apart. 

Your child should be ready to return to day care, kindergarten or school within 2 weeks of the operation.