Hypospadias is a congenital problem which is due to deficient formation of urinary tube or urethra in children. It results in the outlet or meatus of urine resulting in a more proximal or upfront location than usual. The urine in such situation passes from the undersurface of the penis. This position may vary from just the undertip of the meatus to undersurface of the penis to the midline of scrotum and the base of scrotum. The more upfront the position of the urine outlet, the more severe the disease. Along with foreshortening of urethra, there is associated curvature of the penis during erect state. This erect state may bend the penis sufficiently to prevent a successful sexual intercourse when the child is sexually active.
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The treatment should ideally be done at an early age ideally anytime after 6 months. The treatment is done early so as to prevent psychological impairment due to non projectile urinary stream and surgery with dressing.
The surgery for milder forms is single staged and entails minimal admission and dressing. But more severe form may entail staged procedures to correct curvature and urethra( Urethroplasty) as well as Glans ( Glanuloplasty).
No. It is a congenital disease with no medical cure and only surgical therapy.
No. If hypospadias severity is mild or the location of urethral meatus is only slightly displaced with minimal penile curvature, then we may very well follow up the child.
Although it is the child’s individual case which defines the age at which surgery may be needed, but is usually done before school going age of the child to provide a projectile stream to the child to prevent any psychological problems associated with this age group.
Usually, no hormone manipulation is needed but rarely when the penile anatomy is not appropriate then testosterone supplements may be needed either in form of cream, ointment or injection. But the treatment is only temporary without any untowards side effects. Although application has to be done by male member of the family.
The success rates of the surgery vary as per the severity of the disease but for distal or mild hypospadias the success rate is higher as compared to proximal or severe stones. The staged repairs needed for complex scenarios may need individual determination of merits for success.
The cases in which first surgery may not be successful may have small fistula or may need a re-operation to treat the whole problem again. The fistula treatment is usually simple and straightforward.