Neelam, a resident of Gurugram, recently gave birth to a healthy baby boy, but doctors soon discovered that he had a urinary anomaly. After a thorough examination, pediatric surgeons diagnosed him with hypospadias, a condition where the opening of the urethra is located on the underside of the penis rather than at the tip. This condition is the second most common congenital issue in boys, following undescended testicles.
Hypospadias among a male newborn is not an uncommon condition. So parents should not worry and instead need to consult a pediatric surgeon and get necessary corrective measures done Early diagnosis and treatment can restore both the appearance and function of the penis in most cases, as per the doctors.
Prevalence: According to the Hypospadias Foundation, around 1 lakh boys are born in India with this type of anomaly. This number has been calculated from birth rate for infant boys according to the 2011 Census and considering that the worldwide accepted incidence of hypospadias is around 1/150 male births, it said.
In around 70 per cent of cases, the urethral meatus is positioned distally to the shaft, representing a milder form of the disease. The remaining 30 per cent of cases are located proximally, are more complicated, and require further evaluation.
In addition to the hole being in the wrong position, the foreskin is often underdeveloped on the underside, giving it a hooded appearance on top. Occasionally, the penis may also be bent downward (chordee), typically due to tight skin, though it can also result from an abnormality in the structure of the penis itself.
Causes and Risk Factors :Dr. Shandip Kumar Sinha, Director of Pediatric Surgery and Pediatric Urology at Medanta Hospital, Gurugram said that maternal exposure to progesterone during pregnancy may increase the risk of hypospadias in a male fetus.
Moreover, a baby is more likely to have hypospadias if they have a biological relative — father or brother — who also had hypospadias, he said. Diagnosis: According to Dr Sinha, an expert in paediatric surgery and Pediatric Urology, there are 3 key features of hypospadias, although not all are required for the condition.
These features are ventral opening of the urethral meatus, ventral curvature of the penis or ‘chordee’ and dorsal hooded foreskin, he said.
It is typically easy to diagnose hypospadias because the meatus is not located on the tip of the penis. The foreskin may also be underdeveloped, often leaving the underside of the penis uncovered. In some cases, the foreskin appears as a “hood” at the back of the penis. Additionally, the penis may have a downward curve or bend. In more severe cases, the penis can be unusually small or short, and the scrotum may appear divided into two halves, the doctor said.
Healthcare providers typically diagnose hypospadias shortly after birth, as part of the routine physical examination performed by a pediatrician.
Treatment and cure: :he goals of treatment are to reconstruct a straight penis with a meatus as close as possible to normal site to allow a forward directed urine stream and normal coitus in adulthood, Dr Sinha said.
In most cases, treatment involves a single surgery. However, some types may require multiple surgeries.
“When the urethral opening is located near the base of the penis, one may need to use tissue grafts, either from the foreskin or the inside of the mouth, to reconstruct the urinary channel and reposition it correctly,” said Dr Sinha, who has conducted several pediatric surgical conditions like hypospadias and epispadias. Sometimes, testosterone is also used to increase length of penis before surgery.
The ideal age of repair is controversial, although most surgeons agree that repair should be completed before school admissions i.e. three years of age. The typically recommended age for a hypospadias repair is between nine months to two years of age. The reasons are adequate Penile growth, decreased anaesthesia risk, easy to manage the child in post operative period, better healing in children, and child’s ‘defective status’ within the family is not prolonged. Also, genital awareness occur around the age of 18 months and children do not remember about defect in long term.
Dr Sinha assured that the success rate of such a surgery is usually high.
“In some cases, a small hole called fistula can form along the underside of the penis where the new urinary channel was created, leading to urine leakage. Although rare, issues with wound healing or scarring can also occur. If these complications arise, additional surgery may be needed to correct them,” Dr Sinha said.
Dr Prabudh Goel, additional professor, pediatrics surgery at AIIMS-Delhi added, “Treatment of hypospadias depends on the severity of the condition. Sometimes a child’s urinary tract will need to be investigated to make sure that there are no other problems, especially when the abnormality is more severe.”
“Unless very mild, hypospadias is usually corrected by surgery to move the urethral opening to the tip of the penis and close over the hole that was previously there. This will enable the child to urinate standing up and with a straight stream. It will also correct the bend so that the penis is straight and looks normal,” the doctor said. He added that the age for the corrective surgery is usually six to 18 months.
