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Hypospadias Repair
What is
Hypospadias Repair?
Hypospadias repair is surgery to correct a birth
defect in boys called hypospadias. This is a
condition in which the urethra does not properly
exit the penis at the tip.
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Effects
of Hypospadias Repair
Corrective surgery
usually results in a penis that looks normal and
functions normally. Surgery can straighten the
shaft, position the meatus at the tip of the
penis, and remove the hooded foreskin. Patients
are able to stand to void, and sexual activity
and fertility are satisfactory.
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Candidates for Hypospadias Repair
Specific treatment for hypospadias will be
determined by your child's physician based on:
. your child's age, overall health, and medical
history
. the extent of the disease
. your child's tolerance for specific
medications, procedures, or therapies
. expectations for the course of the disease
. your opinion or preference
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Your Consultation
Before
surgery, testosterone injections or creams may
be used to increase penis size and antibiotics
are administered to lower the risk for
infection. A catheter is inserted into the
bladder to drain urine.
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The
Hypospadias Repair Procedure
Surgical repair of hypospadias is done while the
child is unconscious and pain-free (using
general anesthesia). The type of repair depends
on the severity of the defect. Mild defects may
be repaired in a single procedure, while severe
defects may require two or more procedures.
First, the anatomy is thoroughly assessed. The
penile skin is retracted and any curvature is
corrected by removing the hardened tissue or
pinching (plicating) tissue to offset the
curvature. Then, the urethra is extended using
local tissue from the foreskin and the opening
is repositioned at the tip of the glans. If an
adequate amount of tissue is not available,
tissue from inside the mouth may be used.
Finally, the penile skin is replaced and
sutured.
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Recovery
After
surgery, a tube is left in the reconstructed
urethra in all but the simplest cases. This tube
is called a "stent," and its purpose is to allow
free flow of urine while the tissues are
healing. Often there is significant swelling in
the penis, and voiding might be difficult for
your child. The tube is most commonly managed
simply by allowing it to drain into a diaper. In
older children, the tube might be attached to a
drainage bag that is emptied periodically. These
tubes are usually attached to the head of the
penis with one or two stitches, which need to be
cut before the tubes can be removed. The tubes
might be in place for as few as two or three
days, or as long as two weeks. Any change in
drainage from these tubes, or in their position,
should be reported to your doctor immediately.
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Risks
Local
swelling and minor bleeding are common following
surgery to repair hypospadias and usually are
not severe. Antibiotics are continued after the
procedure and infection is rare. Complications
include adverse reactions to anesthesia and
excessive bleeding that may require additional
surgery. Long-term complications that may
require additional surgery include the
following:
. Development of an abnormal opening from the
urethra to the skin (fistula)
. Narrowing of the urethral opening (meatal
stenosis) or the urethra (stricture)
. Formation of ballooning of the urethra
(urethral diverticula)
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Frequently Asked Questions
Q:
What is hypospadias?
A:
Hypospadias can be
a mild defect (with the urethral opening
slightly out of place, near the tip of the
penis) or severe (with the urethral opening
closer to the scrotum). Hypospadias is also
frequently associated with a shortening or
downward bending of the penis and malformation
of the foreskin.
Q:
What causes hypospadias?
A:
The cause of hypospadias is not known. The
condition results from abnormal development of
the urethra in the embryo and not from anything
the parents did or did not do during pregnancy.
Hypospadias will occasionally occur in more than
one male in a family.
Q:
What are the symptoms of hypospadias?
A:
The
following are the most common symptoms of
hypospadias. However, each baby may experience
symptoms differently. Symptoms may include:
-
abnormal appearance of foreskin and penis on
exam
-
abnormal direction of urine stream
-
the
end of the penis may be curved downward
The
symptoms of a hypospadias may resemble other
conditions or medical problems. Always consult
your baby's physician for a diagnosis.
Q:
When is the best time to get treatment?
A:
The
best age at which to have corrective surgery
depends on the size of the penis and degree of
the defect. Repair is usually advised at an
early age, unless the patient is not referred
until he is older. Health professionals
generally recommend repairing genital defects
early, so patients can avoid embarrassment that
can be associated with the condition.
Q:
Why is it necessary to get treatment?
A:
Surgical correction aims to reconstruct a
straight penis with a urethral opening as close
to the tip of the penis as possible. This will
result in a properly directed urinary stream,
straightened penis upon erection and an
appearance similar to a circumcised penis.
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The following list of Urology procedures are
performed at Beverly Hills Medical Group -
please click the links to find out more:
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