Diagnosis:
Hypospadias is usually diagnosed at birth by clinical evaluation of the appearance of the penis. Most boys are then assessed when a few months’ old, so that surgical repair can be planned. The timing of surgery is variable and non – urgent, however initial surgery usually occurs between the age of 6
Symptoms
Hypospadias consist of the opening (meatus) being in a misplaced position. It can be lower on the head of the penis, it can be down on the shaft of the penis or it can occasionally be found at the base of the penis in the scrotum. It can be associated with a hooded foreskin, some rotation of the skin of the penis or some curvature of the penis (chordee).
Normally this condition is diagnosed around the time of birth or in the medical check-ups after that. Occasionally mild forms are identified later on in life or at the time of circumcision. Hypospadias rarely causes symptoms in children.
Causes
Hypospadias is a condition where the opening for the ureter is lower down on the penis than in the classical position at the end.
There are no particular known causes for Hypospadias. It can occur in 1 in 300 births. Some children with complex medical conditions have a slightly higher risk of having Hypospadias but the vast majority of young boys spontaneously present with this condition and is not related to anything else.
Treatment
Many children can have a mild form of hypospadias and conservative management is entirely appropriate. There are a huge number of options and surgery available for hypospadias. The philosophy of our group is to do minimalistic surgery.
One option is to leave the child alone as there is no significant cosmetic or functional impact. Another option is to perform a foreskin reconstruction and a minor hypospadias repair. The third option is a more formal Hypospadias repair. There are of course, other options available for children with a more severe form of Hypospadias where the opening is much closer towards the base of the penis and usually requires reconstructive surgery which is performed in a staged fashion.
Pre-Surgery
Your child will attend the hospital and will need to be appropriately fasted. The procedure will be explained in detail prior. Operation will be performed under general anaesthetic and in a vast majority of cases; child will be able to go home the next. All children do require a catheter to be inserted and have a dressing on, but this will all be explained before and after the operation.
Post Op
If your child has a catheter and a dressing in place, your child will be able to go home with these on. Normally the dressing and catheter is left on for 6– 7 days and you child will return to the hospital at this time to have their dressing removed. All children whether is single stage, first stage or second stage hypospadias repair will require to have a catheter to be inserted and have a dressing on for 7 days. Children having first stage hypospadias repair with graft will have their dressing removed their dressing and catheter removed under general anaesthetic, whereas, those having single stage and 2nd stage repair will have their dressing removed by our specialist nurse. During this time, most children will have a regular course of pain relief such as Nurofen and Paracetamol. They will also be prescribed a preventative antibiotic, such as Trimethoprim/Augmentin and an anticholinergic in order to relax their bladder muscles and help with bladder spams. Some children do suffer from bladder spasms with the catheter in place and hence the reason for the bladder relaxant. It is important that the bladder relaxant medication is stopped the night before the dressing is removed in order to ensure the child is able to void the following day when the catheter is removed.
During the time the dressing is in place, we recommend to keep the area dry and clean. No baths are allowed as this would disrupt the dressing and be very uncomfortable for the child. The easiest way forward is once the dressing and catheter are removed, the child can have regular baths and return to normal activity.
FAQ’s
Hypospadias is a condition where the opening for the ureter is lower down on the penis than in the classical position at the end.
02.What are the causes?
There are no particular known causes for Hypospadias. It can occur in 1 in 300 births. Some children with complex medical conditions have a slightly higher risk of having Hypospadias but the vast majority of young boys spontaneously present with this condition and is not related to anything else.
03.What is the appearance of a Hypospadias?
Hypospadias consist of the opening (meatus) being in a misplaced position. It can be lower on the head of the penis, it can be down on the shaft of the penis or it can occasionally be found at the base of the penis in the scrotum. It can be associated with a hooded foreskin, some rotation of the skin of the penis or some curvature of the penis (chordee).
Normally this condition is diagnosed around the time of birth or in the medical check-ups after that. Occasionally mild forms are identified later on in life or at the time of circumcision.
Many children can have a mild form of hypospadias and conservative management is entirely appropriate. There are a huge number of options and surgery available for hypospadias. The philosophy of our group is to do minimalistic surgery.
One option is to leave the child alone as there is no significant cosmetic or functional impact. Another option is to perform a foreskin reconstruction and a minor hypospadias repair. The third option is a more formal Hypospadias repair. There are of course, other options available for children with a more severe form of Hypospadias where the opening is much closer towards the base of the penis and usually requires reconstructive surgery which is performed in a staged fashion.
Your child will attend the hospital and will need to be appropriately fasted. The procedure will be explained in detail prior. Operation will be performed under general anaesthetic and in a vast majority of cases; child will be able to go home the same day. Most children do require a catheter to be inserted and have a dressing on, but this will all be explained before and after the operation.
If your child has a catheter and a dressing in place, your child will be able to go home with these on. Normally the dressing is left on for 5 – 7 days and you child will return to the hospital at this time to have their dressing removed. During this time, most children will have a regular course of pain relief such as Nurofen and Paracetamol. They will also be prescribed a preventative antibiotic, such as Trimethoprim and an anticholinergic in order to relax their bladder. Some children do suffer from bladder spasms with the catheter in place and hence the reason for the bladder relaxant. It is important that the bladder relaxant.
If you have any questions or problems either before or after the surgery, please do not hesitate to contact Nasra Ahmed, Complex Surgical/Pain Lead Nurse, on 020 7580 4400, 10838 (09:00 – 17:00 Monday to Friday) or email at: [email protected]
