Hypospadias is a condition of the external genitalia in a male newborn. Parents’ main question is what will be the future of their sexual health.

The urethral opening normally opens at the top of the glans with small deviations and in newborns at birth it is not visible due to the normal gagging that occurs in almost all of them.

What is hypospadias?

Hypospadias is the pathology that the boy shows in the area of ​​the external genitalia and concerns the formation of the urethra and the position of the urethral opening (ie where the urine comes out). It is considerably more common than two decades ago with an incidence of 1 in 500 to 300 boys born.

Why does it appear?

The etiology for the appearance of hypospadias is due to specific factors and these are:

1. Endocrine (from the growth of his testicles and maternal due to the mother’s estrogens).
2. Environmental (due to the feminization of the environment).
3. Genetic (ie inheritance of genes).
The expression of androgens produced by the testes of the fetus but also a disruption of the hormonal cycle between the mother and the fetus seems to affect the normal development of the genitals due to the effect of hormones that target these tissues. In the environment, on the other hand, substances (medicines, fertilizer, plastic) are widely used that contain small amounts of estrogen that reach us through the food chain.

It is usually recognized at the birth of the boy, while more rarely in more serious forms of the condition it can be shown during the prenatal check-up.

The severity of the pathology is judged by the location of the urethral orifice in the body of the penis, in the scrotum or even lower in the perineum. In particular, it is considered a mild form when the opening is inside the glans, but not at the top, and a severe form when the location of the opening is in the perineum or the scrotum (which can also be split in half). Another important factor that proves a more severe form of the condition is the appearance of bending in the body of the penis (that is, the curvature of the mole towards the testicles).

In 7 to 8 boys out of 10, who are born with hypospadias, the form of the condition they show is judged to be mild and this means that the urethral orifice is located in the last 1/3 of the penis. In about 2 of them, the orifice is probably too narrow and needs to be dilated to allow urine to pass unhindered.

Surgical intervention

The surgical intervention aims at restoration, both aesthetically and functionally. Aesthetically, we seek to create a urethral opening as close as possible to the top of the glans, for the glans to take a normal conical shape, for the penis to not bend and of course circumcision is performed, i.e. the excess of the foreskin is removed which is missing from its anterior surface penis. In addition, a properly positioned urethra ensures an unobstructed urination, i.e. a normal flow that allows the boy to urinate standing up.

When is the operation performed?

In terms of time, such surgery is performed in the first months of life and specifically according to the guidelines of the American Academy of Pediatrics in the last months of the first year between the 9th and the 12th.

We also have an important observation regarding the timing of such surgeries from the child psychiatrists who recommend the same period, since according to studies, boys become aware of their external genitalia after the age of 12 to 18 months. Also, the incidence of psychological and anesthetic stress in these ages is lower.

Regarding the surgery and the result we want to achieve, several techniques have been described depending on the form of the hypospadias. The first assessment for the technique to be used is usually given at the age of 6 months, when the 1st visit to a specialist doctor must be made. In most cases, a urethral catheter is placed during the surgery, which acts as a splint at the urethroplasty site. The catheter needs to remain for 5 to 7 days in the cases where it will be placed. The length of hospitalization for these boys is one day.

In a very mild form of hypospadias the catheter is not necessary and of course the boy is discharged the same day.

Risks that may arise from this surgery are of course a local infection and bleeding. The treatment of which is conservative and in this case the result of the surgery should be assessed after 4 to 6 weeks.

Complications in these surgeries depend on the severity of the hypospadias, but the most common ones, such as a urethrodermal fistula or a stricture of the urethral orifice, affect 1 to 2 children out of 10 who will be operated on and obviously need reoperation as the goals of the surgery have not been achieved. treatment. A second minor surgery is usually performed after 6 months or more to correct them.
It is documented that these boys do not present any problems in their later sexual life, as well as their paternity chances and quality of life are not affected.