The urinary tract system and male reproductive system are intertwined. Within both, the urethra plays an integral role in the natural expulsion of urine and sperm. Although they originate from different areas within the body, they’re both carried through the urethra where they exit the body through the meatus. Many boys are born with these in anatomically correct positions, but there are circumstances that can lead to anomalies. One of these is hypospadias. To help you better understand, here’s what every parent should know about this congenital condition and how to treat it.
What is Hypospadias?
Hypospadias is a type of congenital defect that affects the male urethra. It’s characterized by an abnormal development, where the meatus is displaced. The meatus is the urethral opening, typically located on the tip of the penis. The meatus in babies born with hypospadias is located elsewhere, usually on the underside of the penis. This is a fairly common congenital anomalies, occurring in about 1 in every 200 boys but treatment can correct the positioning. There are three specific types of hypospadias, which are described based on where the urethra opens. They include subcoronal, midshaft, and penoscrotal hypospadias.
- Subcoronal – the meatus is located near the head of the penis
- Midshaft – the meatus is located along the penis shaft
- Penoscrotal – the meatus is located in the area where the penis and scrotum meet
Symptoms of Hypospadias
The most obvious symptom of hypospadias is the displacement of the meatus. However, there are also a few more subtle signs in mild cases. Many children who experience hypospadias also have chordee, which is a penis that curves downward. This may be accompanied by an undescended testicle or undeveloped foreskin. Because of the location of the meatus, children with hypospadias will also have an abnormal stream of urine.
Causes of Hypospadias
It’s important to understand that there’s nothing an expecting mother could have done during pregnancy to result in hypospadias. With that being said, the direct cause of hypospadias is still relatively unknown. Although there seems to be a genetic link, it’s not guaranteed that a child will be born with hypospadias if their father or brothers have it.
During pregnancy, your baby’s body parts develop at different times. In boys, the penis begins to develop around the eighth week of pregnancy. It continues throughout the pregnancy, but hypospadias tends to occur at some point between weeks nine and 12. Although this congenital anomaly is not something that any mother should blame herself for, there are some things that could increase the risk. These include:
- Undergoing fertility treatment
- Using hormones either before or during pregnancy
- Smoking
- Geriatric pregnancy (over the age of 35)
- Obesity
- Exposure to pesticides
- Premature births
Although hypospadias isn’t directly preventable, there are plenty of ways to decrease your risk of it occurring. This mainly includes focusing on your health throughout your pregnancy. This should always include attending your scheduled prenatal visits with your doctor, maintaining a healthy weight, avoiding alcohol, tobacco, and other drugs, and taking between 400 to 800mcg of folic acid each day.
How to Treat Hypospadias
Most cases of hypospadias are diagnosed in the hospital, shortly after delivery. Since it’s fairly easy to notice the problem, you’ll receive a referral for a pediatric urologist before leaving the hospital. This is important, as pediatric urologists are well versed in these types of issues and understand how to move forward with treatment in children. Surgery is the only way to ensure that the position of the meatus is corrected. However, the type of treatment may vary based on each individual and the severity of the hypospadias. Some children may need to undergo further testing to ensure that there are no underlying abnormalities that could continue to cause issues after corrective surgery.
What to Expect in Hypospadias Surgery
During the surgery, the goal is to reposition the meatus and urethra into the correct position while addressing any signs of chordee (downward penile curve). If your baby has hypospadias at birth, it’s important to avoid circumcision as this extra skin may be needed during the corrective surgery.
Your baby will be placed under a general anesthesia during the surgery and will not feel any pain at all. The procedure will focus on straightening the penis, constructing a new urethra, repositioning the meatus to the tip of the penis, and reconstructing the foreskin. Sometimes, depending on the severity, two separate surgeries are required: one for the urethral restructuring and one for penile straightening.
Post-Op Care and Recovery
Transferring from hospital to home after your child’s urologic surgery is fairly straightforward. In most instances, you can take your baby home on the same day as the surgery. Since the procedure occurs during infancy, the aftercare needs to be closely monitored by you and your partner. Your doctor will provide you with all of the information you need to do this.
Most children who undergo hypospadias surgery will need a pediatric catheter or a urethral stent for a week or so following the surgery. This will give their urinary tract the support it needs to properly heal. You may notice some slight bleeding or incomplete correction of the bend. If this happens, call your doctor to determine the best course of action.
You will need to apply Vaseline to your child’s diaper or use a pad in their underwear to reduce the risk of the penis sticking to clothing. You’ll receive instructions on how to do this. Oral antibiotics may be needed, along with pain relief. Your doctor will also show you how to clean the wound and dress it to help facilitate the healing process. If, at any time, you’re unsure about how to care for your child during post-op, don’t hesitate to contact your doctor. Any signs of a fever or infection also warrant prompt contact with your doctor to help reduce the risk of more serious complications.
Risk of Hypospadias Surgery
As with any surgery, there are a few risks when undergoing hypospadias treatment. The most common one is meatal stenosisor the development of a urethral fistula. Both of these risks are easy to correct and reverse if they occur, however it will require an additional surgery. These are much shorter surgeries than a hypospadias treatment and most surgeons agree that it’s still best to move forward with corrective surgery.
When to Schedule Hypospadias Surgery
Typically, the sooner you correct hypospadias through surgery, the better. Since your baby will be in diapers during the first few months of their life, there’s no real rush to complete it. Ideally, many surgeons recommend waiting until sometime between about six and 18 months, depending on the severity of the case. If you’d prefer a different timeline, talk to your pediatrician or surgeon. Thanks to the type of surgery and low risk factor, hypospadias correcting surgery can typically be done at any age.
Hypospadias Long-Term Prognosis
Since most cases of hypospadias are mild and can be easily treated with surgery, the long-term prognosis is optimistic. With early treatment, your child will grow up to have completely normal genitalia. In fact, many men cannot tell the surgery was ever performed once they’re older.
If you notice any signs or symptoms of hypospadias during the first few months of your child’s life, contact your pediatrician to learn about next steps. However, many cases of this congenital anomaly are recognized and diagnosed in the hospital during delivery or your baby’s initial wellness exam. Don’t worry if your baby has been diagnosed with hypospadias, as treatment is safe and effective. Your child will grow up to have a completely normal, healthy life! To help aid in recovery, Byram Healthcare has a range of pediatric catheters and supporting supplies to make pediatric urology treatments at home as easy as possible. For management of chronic conditions, Byram Healthcare has the products and support you need to live a happy, healthy life. Our mission is to help improve health outcomes and affordability of care for people living with chronic diseases.
Byram Healthcare is a member of the National Association for Continence’s Trusted Partners Program, whose mission is to provide quality continence care through education, collaboration and advocacy. We continue to build partnerships in the clinical community to ensure we focus on what’s best for the patient.
