Hypospadias Repair Surgery

Hypospadias repair is surgery to correct a defect in the opening of the penis that is present at birth. The urethra (the tube that carries urine from the bladder to outside the body) does not end at the tip of the penis. Instead, it ends on the underside of the penis. Hypospadias repair involves surgery for the abnormally placed opening on the tip of the penis, which can be distal, proximal, mid-penile… The procedures can be through the use of Mathieu, MAGPI, TIP, GAP, etc, and there are possible complications such as fistulas. The penis plays two important roles in males by being a pathway both for urine and semen (sperm) to leave the body. Both fluids go out through a tube called the urethra, which opens at the end of the penis.  Formation of the penis takes place between 9 & 12 weeks of pregnancy. It is during this period that the male hormones tell the body to form the urethra and foreskin.  Sometimes, while the baby is still in his mother’s body, this opening fails to develop completely to the end of the penis and may instead be located anywhere along the underside of the penis. This condition is called hypospadias, and it is congenital, meaning that your child was born with it.  Many times children with hypospadias may also have an abnormal bend of the penis shaft, and a partially developed foreskin, the fold of skin at the end of the penis. The hypospadias repair surgery will reposition the opening and give the penis a more normal appearance.  WHAT IS HYPOSPADIAS REPAIR SURGERY? Hypospadias repair surgery is a surgical procedure that fixes hypospadias, which is an abnormally placed opening at the end of the penis. The procedure is mostly carried out on children because hypospadias is a congenital disorder, noticed at birth. But it can still be performed in adults. Hypospadias is a congenital abnormality where the urethral fold and the ventral foreskin is not fully developed in a fetus during conception. This disorder may or may not cause penile curvature and the urethral opening is proximally located in between the perineum and tip of the penis. Hypospadias is classified into three categories, which includes:

• Anterior or Distal Hypospadias

The tubular opening (meatus) on the end of the penis is located at the subcoronal or corona.

• Mid-penile Hypospadias

The meatus is located on the proximal penile shaft, the middle of the penile shaft, or the distal penile shaft.

• Posterior or Proximal Hypospadias

Here, the urethral opening is located on the scrotum, the penoscrotal, or the perineal. REASONS FOR THE SURGERY Hypospadias repair surgery can be done for the following reasons:

1. To reposition the tubular/urethra opening (meatus) at the right position on the end of the penis.
2. To improve on the abnormal bend of the penis.
3. To restructure the partially developed foreskin on the penis.
4. To correct any abnormality on the penis and give it a normal appearance.

QUALIFICATIONS FOR PROCEDURE Hypospadias is a congenital abnormality, meaning it is noticed at birth, therefore the surgery is mostly performed on children. In general, any person born with a penis that doesn’t look normal and works normally is qualified for hypospadias repair surgery.  TYPES OF HYPOSPADIAS REPAIR SURGERY The steps in performing hypospadias repair depend on the types of techniques to be used. The different techniques include:

• The Meatal Advancement And Glanuloplasty (MAGPI) Technique.

This one of the most commonly performed hypospadias procedures. It involves meatal reconfiguration by resecting the abnormal openings and performing glanuloplasty. Afterward, a silicone feeding tube catheter is positioned in the bladder and sutured with polypropylene traction. It has been recorded to have a high success rate, with low complications and no need for future reoperation.

• The Tubularized Incised Plate Urethroplasty (TIP) 

This procedure involves meatal configuration by tubularization using a 6/0 running suture from the dorsal to the ventral side of the penis, and glanuloplasty is done at the abnormal opening. The procedure has a high complication rate compared to that of MAGPI. However, it has a more satisfactory aesthetic look.

• The Glans Approximation Plasty (GAP) Procedure

This procedure involves closing the urethral plate is wide enough to be closed without the relaxing incision in the dorsal aspect of the urethral plate.

• Mathieu Procedure Based On A Meatal Flap

This procedure uses the degloved skin shaft flap to fold over the length between the urethral defect from the meatus to the glans tip. The opening is repositioned to the tips of the glans penis and sutured. Some other techniques include:

• The transverse island flap (TIF)
• The Koyanagi-Nonomura one-stage repair for severe perineal hypospadias.
• The tabularized incised plate urethroplasty (TIP)

STEPS & PROCEDURES OF HYPOSPADIAS REPAIR SURGERY Before undergoing a hypospadias repair surgery, your surgeon will examine to confirm the type of hypospadias and you will be expected to stop any intake of NSAIDs or blood-thinning drugs a few weeks before the surgery. You will be required to stay in the hospital for a few weeks for monitoring. During Surgery, You will be placed on general anesthesia and your heartbeat and blood pressure rate will be monitored. 

• An incision will be made according to the type of technique used. 
• Shaft skin deployment will be carried out. 
• Glans rings are created.
• Granuloplasty, resection, tubularization, etc, according to the techniques, will be performed. 
• Sutures of the skin and meats are made.
• Stitches are made in a traditional circumferential closure.
• The surgical area is cleaned and bandaged.
• An excretion bag is attached to the bladder via a catheter to aid in passing out urine.

After Surgery, You will be moved to the ICU to be closely monitored for a day or two and thereafter, will be moved to his hospital room. Pain killers will be administered to numb pains and antibiotics to prevent infections. RECOVERY RATE You or your child may have to stay in the hospital for at least 1 to 2 weeks. You may be able to return to work, school, and normal activities 3 to 6 weeks after the surgery.  The recovery rate will be faster if the following guidelines are adhered to:

• Keep the surgical area clean and dry always.
• Change the bandage on the area every day.
• Disinfect the area every day.
• Give painkillers to reduce pains.
• Give antibiotics to prevent infections.
• If swelling is noticed, use ice packs on the area.
• Restrain from engaging in rigorous activities till fully recovered.
• Visit your surgeon for routine check-ups.
• If some complications persist, contact your doctor.

COMPLICATIONS The risk of this repair surgery are likely to include the following:

• Damage to nerves in the penis
• Rupture of veins in the penis.
• Infections,
• Swollen penis,
• Scar tissues,
• Fistulas,
• Meatal stenoses, etc.

SUCCESS RATE As earlier stated, the hypospadias repair surgery is mostly done on children and the success rate of the surgery is high. Research shows that the success rate of this procedure is estimated at 90% to 95% depending on the method of surgery performed.

Symptoms

• Opening of the urethra at a location other than the tip of the penis.
• Downward curve of the penis
• Hooded appearance of the penis because only the top half of the penis is covered by foreskin.
• Abnormal spraying during urination.

Causes

• As the penis develops in a male fetus, certain hormones stimulate the formation of the urethra and foreskin.

• Hypospadias results when a malfunction occurs in the action of these hormones, causing the urethra to develop abnormally. In most cases, the exact cause of hypospadias is unknown.

FAQ

Can an adult undergo a hypospadias repair surgery?

Yes. Hypospadias repair surgery can be performed in adulthood. The success rate is just as high as those performed in children.

• How long can you wait after the surgery until you can have sex?

The recovery rate for hypospadias repair surgery is estimated between 3 to 6 weeks. However, sex should be when you are fully healed with no fear of complications. Having sex when not healed can cause pains, suture and incision rupture, dislocation of the resected me at us, etc.

• How long does a hypospadias repair surgery last?

Due to the complexity of the procedure, depending on the techniques involved, the surgery can last for 4 to 8 hours.

• How painful is hypospadias repair surgery?

Surgeries that involve genitals can be very painful. However, pain killers can be continuously taken to control the pains. It may take 1 to 3 weeks for the pains to be non-present.

• At what age should you have a hypospadias repair surgery?

Hypospadias is a congenital abnormality found in male children at birth. However, repair surgery can be done at any age from childhood to adulthood. But in most cases, the surgery is performed on children between few weeks to 5 years.