Hypospadias / Chordee
Hypospadias is a common birth defect of the penis. The urethra (the tube that carries urine from the bladder to outside of the body) is not located at the tip of the penis. It can be located anywhere on the undersurface of the penis to the scrotum.
A condition called chordee is frequently associated with hypospadias. Chordee is an abnormal downward curve of the penis. This can occur with or without a hypospadias.
Classification of hypospadias is done by the position of the urethral opening. Most often the opening is found near the head of the penis. This is known as distal or glanular hypospadias. When it is located from the middle to the lower shaft of the penis, it is called midshaft hypospadias. When the opening is on the scrotum it is called penoscrotal and when it is behind the scrotal sac it is called perineal. These are the most severe forms of hypospadias.
Cause
Genetic, environmental and hormonal influences affect this urologic abnormality.
Symptoms
Usually, hypospadias is noticed at birth. Along with the misplaced opening, frequently, the foreskin is incomplete and forms a hood. This is called a dorsal hood. However, some newborn boys have abnormal foreskin with a normal positioned urethral opening.
During the ninth to twelfth week of fetal (unborn child) development, the urethral opening does not completely form at the tip of the penis. This occurs in one out of every 150 to 300 boys. There is a familial tendency that if one boy has hypospadias, another son has a 15 percent chance of having the condition. Eight percent of fathers who have a son with hypospadias also had the condition.
If a hypospadias and/or chordee deformity is not repaired, the following complications may occur as your child grows:
- Your child's urine stream may be difficult to direct and control
- The penis may curve as your child grows causing sexual dysfunction later in life
- If the urethral opening is near or behind the scrotum, your child may have fertility problems later in life
Treatment
No medicine will correct a chordee or hypospadias and the child will not outgrow these conditions. Surgery is recommended and is almost always successful when performed by an experienced pediatric urologist.
The goals of the surgery are as follows:
- To bring the urethral opening to the tip of the penis to allow a controlled stream of urine while standing
- To straighten the penis, if a chordee is present, therefore allowing an unrestricted erection
- To improve the appearance of the penis
- To divert fertility issues later in life
Doctors prefer to perform the hypospadias surgery between 6 -24 months. However, the surgery can be done at a later age. The surgery is usually done on an outpatient basis.
At birth, your male child will not be able to undergo a circumcision because the foreskin may need to be used for the surgical repair.
Most hypospadias surgeries create a penis that functions well and looks very near normal.
The surgery is done while the patient is asleep, under general anesthesia. Occasionally, the surgeon may prefer that the child not urinate through the repaired urethra during the first few days. A small plastic tube, called a catheter, is anchored to the head of the penis with stitches. This allows the urine to flow out without coming into contact of the repair. This tube will be removed in 7-14 days in the office without causing the patient much discomfort.
A dressing will be wrapped around the shaft of the penis at the end of the surgery. This will help hold down the swelling and make your child more comfortable. Remove this dressing if your child doesn't urinate within 8 hours or if it rolls down and starts to tighten around the penis.
Prescriptions for antibiotics (medicine that will kill bacteria) and a medication to stop bladder spasms maybe given to the patient.
Hypospadias surgery is very successful, but there are some potential complications. In some instances, a hole or a fistula may occur and urine may leak through the hole. The urethra would need additional surgery to repair this. Scarring within the urethra may occur and cause narrowing of the urethra. This may interfere with the passage of urine and would also need to be corrected with surgery. Most complications are easy to repair with additional procedures.
Patients may need to return for checkups until after puberty.
When to Call the Doctor
After surgery, call for the following reasons:
- Your child can't urinate or has difficulty urinating
- Your child has severe pain or bladder spasms that can't be controlled with medication
- Your child has a fever of 101°or higher during the week after surgery
- Your child has vomited more than 3 times and can't keep liquids down
- The blue stitches in your child's stent (tube) become dislodged or fall out
Rev. 10/07
