Hypospadias is a congenital condition in boys (occurring during development in the womb) where the opening of the urethra (the tube that carries both urine and sperm outside of the body through the penis) is not in its normal position at the tip of the penis, but rather the opening is located on the underside of the penis.
Rest assured that if your son is born with this condition, Dr. Robert Mevorach and the team at Chesapeake Urology For Kids are well versed in techniques to correct the problem. The team understands that this is also a stressful time for you as parents and will walk you through the process of treatment, which will entail surgery to correct your son’s anatomy and help ensure normal development as he grows. You will develop a long-term relationship with the pediatric urology team, from initial diagnosis and treatment through recovery and follow-up exams.
Surgery will often be necessary to correct your son’s condition. Dr. Mevorach has many years of experience performing the surgical procedure to correct hypospadias with a focus on full reconstruction of the structures that did not fully develop. The success of the surgery to correct hypospadias is high and the outlook for children who undergo the procedure to correct hypospadias is very good, with the majority of cases resulting in a good cosmetic appearance and a fully functioning penis.
Right after birth, your son will have a physical examination which will find the anatomical condition of hypospadias, in most cases. You will be referred to a pediatric urologist who is well trained in treating and correcting the condition.
Your pediatric urologist will determine the severity of the hypospadias and extent of the reconstruction needed. In some cases, the opening may be near the tip of the penis and in more severe cases the urethral opening may be located near the base of the penis or near the scrotum.
During your son’s initial physical exam, in addition to finding the urethral opening underneath the penis, the physician might also find that your son had associated conditions such as:
- Chordee, or a downward curve of the penis
- A downward urine stream
- Extra foreskin, forming a "hood" over the back of the penis
- An abnormal appearance of the glans, or tip of the penis
Treatment for Hypospadias
The treatment for any form of hypospadias is surgery performed by Dr. Robert Mevorach, who is experienced in the condition as well as the complexity of the procedure itself. Surgery is typically performed as an outpatient procedure between four and 10 months of age.
Dr. Mevorach and his team will sit with you to outline the procedure and what you can expect to ensure that you are comfortable with the surgery. He will also explain what you can expect after surgery and the recovery process.
The outcomes are typically very positive for boys who have surgery to correct hypospadias. Dr. Mevorach stresses to parents that it is important to maintain a positive outlook and to feel confident in the hands of a well-trained pediatric urologist and the experienced team at Chesapeake Urology For Kids. You and the pediatric urology team will be building a long term relationship that will help ensure the success of the repair as your child grows and matures.
There are three main elements of surgery to repair and correct hypospadias:
- Urethroplasty – This surgical approach rebuilds the urethral channel and repositions the urethral opening at the tip of the penis so that urine can flow out of the penis properly. While there are several techniques for repairing the channel, Dr. Mevorach adapts each procedure to the individual child’s anatomy.
- Orthoplasty – This procedure straightens the penis when chordee (downward curve of the penis) is present.
- Cosmesis – This component of the surgery focuses on the cosmetic look of the penis after the reconstruction of the urethral channel, removing the extra foreskin so that the penis looks similar to a circumcised penis.
The surgery typically lasts one to two hours and is performed in our Ambulatory Surgery Center, which caters to the special needs of our pediatric patients. Your son will be placed under general anesthesia by our pediatric anesthesiologist. You will be able to meet your child following the procedure in the recovery room and will be able to go home that same day if no complications occur or additional monitoring is necessary.
In all cases of hypospadias, additional surgeries may be necessary to repair and reconstruct the urethral opening. Multiple or staged surgeries may be planned for optimal results in certain children.
What To Expect After Surgery
While your son is in recovery, our pediatric nurses will walk you through the care of the surgical site once you return home, which will include instructions for keeping the site clean and changing the dressing.
During surgery, a stent, which is used to drain urine from the bladder out through the urethra, may be placed into the reconstructed opening. It may remain in the urethra during the healing process to keep the urethra open and will be removed at your follow-up appointment.
Dr. Mevorach may also prescribe:
- Ibuprofen or Acetaminophen for pain or soreness following surgery
- An ointment that should be applied to the surgical site (A&D, Aquafor)
- Oral antibiotics
Your first follow-up appointment may be seven to 10 days after surgery if a stent was left in the surgical site. If no catheter was placed, the follow-up may be two to three months after the initial healing process. Significant swelling and normal post-operative skin changes require four to six months to resolve in order to judge the initial surgical result.
Remember –Dr. Mevorach and the pediatric urology team are always available to answer any questions you may have before or following your son’s surgery. Feel free to call our office any time. Open communication is an important part of the process.