Hypospadias Treatment : Methods, Prevention & More

Overview

Hypospadias is a condition where the opening of the urethra is not at its usual place. Instead of the tip of the penis, the urethra opens on the underside of the penis or way back near the scrotum (a sac-like structure located under the penis that contains the testicles). The urethra is a tube-like structure that carries urine from the bladder and exits your body. 

This condition is diagnosed in male babies at the time of birth. Surgery is the treatment of choice for hypospadias. Surgery usually restores the shape of the penis and the natural placement of the urethral opening. With successful treatment, babies can pass urine.

What Is Hypospadias?

Hypospadias is a fairly common condition seen in about 1 in every 200 baby boys. In this condition, the urethral opening is not in its usual place. Instead of the tip of the penis, the urethral opening is placed on the underside of the penis. Depending on where the opening is located, hypospadias is of three types-

• Subcoronal- In this type, the opening is located close to the head of the penis.
• Midshaft- Here, the opening lies on the underside of the shaft of the penis
• Penoscrotal- In this type, the opening lies very far, at the junction of the penis and the scrotum.

 Since the opening of the urethra is far away from the tip of the penis, the shaft of the penis is usually bent. The farther the opening is from the tip of the penis, the greater the bend in the penis. This condition is known as ‘chordee.’ The foreskin is also not well developed in most cases. Surgery is the treatment of choice for hypospadias. It is done at 3 to 18 months of age.

What Causes Hypospadias?

The exact reason why hypospadias occurs is unknown. In most cases, it is thought to be a combination of several factors that leads to the development of hypospadias.

Hypospadias runs in the family. At around the 9th to 12th week of pregnancy, the urethra and penis start developing. There are several factors related to the mother that influence this development-

• Age of the mother: Women over the age of 40 have a higher chance of delivering a baby with hypospadias
• Obesity in the mother: Mothers carrying extra weight have been seen to deliver boy babies with hypospadias
• Assisted pregnancies: Women who have undergone fertility treatments to get pregnant have a high chance of delivering a baby boy with hypospadias. The progesterone hormone is believed to play a role here.
• Exposure to chemicals: Being exposed to chemicals such as pesticides for a long term can increase the risk of hypospadias.
• Smoking: Smoking before and during pregnancy can put the baby at high risk of developing hypospadias.

What Are The Symptoms of Hypospadias?

The symptoms of hypospadias can vary depending on the severity of the condition. Here are some common symptoms:

• Abnormal Urinary Stream: The urine stream may not be directed forward as it should be but instead deviates downward or to the side due to the location of the urethral opening.
• Abnormal Penile Appearance: The penis may have a curved or bent appearance. The extent of the curvature can vary depending on the severity of the hypospadias. In severe cases, the penis may appear shorter or have a hooded appearance.
• Malposition of Urethral Opening: The urethral opening is not located at the tip of the penis (glans) but is found on the underside of the penis. The location can vary, with more severe cases having the opening closer to the scrotum or perineum.
• Difficulty with Urination: In some cases, hypospadias can cause difficulties with urination, such as spraying or dribbling of urine. This can be due to the abnormal location of the urethral opening.
• Chordee: Chordee is a condition commonly associated with hypospadias, where the penis curves downward or is bent during an erection. This can cause discomfort during sexual activity in adulthood.

It's important to note that the severity of hypospadias can vary, with some cases being relatively mild and others more severe. Mild cases may not present significant symptoms and may be discovered during routine physical examinations. Severe cases may have more noticeable symptoms and require surgical correction.

Also Read: hydrocele

How Is Hypospadias Diagnosed?

Here's an overview of the diagnostic process for hypospadias:

• Physical Examination: The healthcare provider, usually a pediatric urologist or urologist specializing in genitourinary conditions, will perform a physical examination of the genital area. They will carefully assess the location of the urethral opening, the appearance of the penis, and the presence of any associated abnormalities such as curvature (chordee).
• Medical History Assessment: The healthcare provider will ask questions about the individual's medical history, including any family history of hypospadias or other congenital conditions. They may inquire about any symptoms or difficulties with urination.
• Voiding Studies: In some cases, the healthcare provider may order additional tests to evaluate the urinary system. Voiding cystourethrography (VCUG) or uroflowmetry may be performed to assess the flow of urine, identify any abnormalities, or determine the presence of associated conditions such as vesicoureteral reflux (a condition where urine flows backward from the bladder into the kidneys).
• Imaging Studies: Imaging studies such as ultrasound may be used to evaluate the urinary system and assess the presence of any associated abnormalities, such as abnormalities in the kidneys or bladder.

The diagnosis of hypospadias is primarily based on the physical examination findings, specifically the location of the urethral opening. The severity of hypospadias can vary, with mild cases having the urethral opening closer to the tip of the penis, while more severe cases may have the opening located closer to the scrotum or perineum.

How Is Hypospadias Treated?

The treatment of hypospadias typically involves surgical correction to reposition the urethral opening to the tip of the penis and restore normal appearance and function. The specific surgical technique used depends on the severity of the hypospadias and individual factors. Here are some common approaches to treating hypospadias:

Surgical Repair: The mainstay of treatment for hypospadias is surgical correction. The surgery is usually performed by a pediatric urologist or a urologist specializing in genitourinary conditions. The procedure involves repositioning the urethral opening to the tip of the penis and reconstructing the urethra. The surgical technique used depends on the location and severity of the hypospadias.

• Mild Cases: For mild cases where the urethral opening is closer to the tip of the penis, a single-stage repair may be performed. The surgeon may use tissue from the foreskin or inner lining of the mouth (buccal mucosa) to create a new urethra and move the opening to the tip of the penis.
• Severe Cases: In more severe cases where the urethral opening is closer to the scrotum or perineum, a two-stage repair may be necessary. In the first stage, the surgeon may create a neourethra using tissue grafts or other techniques, and a temporary tube (stent) may be placed to keep the neourethra open. In the second stage, typically performed several months later, the stent is removed, and the new urethra is connected to the tip of the penis.

Chordee Correction: In some cases of hypospadias, there may be associated curvature of the penis (chordee). Surgical correction of the chordee may be performed concurrently with the hypospadias repair to straighten the penis during an erection.

Also Read: Urethral Stricture Disease

What are the Complications of Hypospadias?

Hypospadias is a congenital condition that can be associated with certain complications. While not all individuals with hypospadias will experience these complications, it's important to be aware of them. Here are some potential complications of hypospadias:

• Urinary Problems: Hypospadias can affect the normal functioning of the urinary system. Depending on the severity of the condition, individuals may experience difficulties with urination, such as spraying or dribbling of urine. 
• Chordee: Chordee refers to the downward curvature or bending of the penis. It often occurs in conjunction with hypospadias. Chordee can interfere with normal sexual function and may cause discomfort or difficulty during sexual activity in adulthood.
• Cosmetic and Psychological Impact: The abnormal appearance of the penis due to hypospadias can cause emotional and psychological distress, particularly during adolescence and adulthood. Individuals may experience self-esteem issues, body image concerns, or anxiety related to their sexual identity.
• Fistula Formation: Fistulas are abnormal connections or passages between different body structures. In the context of hypospadias, urethrocutaneous fistulas may develop as a complication of surgical repair. These are small openings that form between the reconstructed urethra and the skin, resulting in urine leakage. Fistulas may require additional surgical intervention to correct.
• Urethral Stricture: Urethral strictures are narrowing or blockages in the urethra. They can occur as a result of scarring or abnormal healing after hypospadias surgery. Urethral strictures may cause urinary flow problems, recurrent urinary tract infections, or difficulties with voiding.
• Recurrence or Residual Hypospadias: In some cases, hypospadias repair surgery may not completely correct the condition and residual hypospadias may persist. Additionally, in rare instances, the repaired hypospadias may recur over time, requiring further surgical intervention.

It's important to note that the likelihood and severity of these complications can vary depending on the individual, the severity of hypospadias, and the success of surgical repair.

How to Prevent Hypospadias?

While it may not be possible to completely prevent hypospadias, there are some steps that can be taken to potentially reduce the risk.

• Avoid Environmental Exposures:  It may be beneficial to limit exposure to potentially harmful substances during pregnancy, such as certain pesticides, industrial chemicals, and endocrine-disrupting compounds. 
• Maintain a Healthy Lifestyle: This includes a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Adequate intake of essential nutrients, including folic acid, may also be beneficial. Additionally, avoiding smoking, excessive alcohol consumption, and illicit drug use can help promote a healthy pregnancy.
• Genetic Counseling: If there is a family history of hypospadias or other congenital abnormalities, genetic counseling can provide valuable information on its prevention.

It's important to note that while these strategies may be beneficial in promoting overall health and reducing certain risks, their direct impact on preventing hypospadias is not definitively established. 

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