Surgery for Severe Hypospadias

I have read many stories in the HEA e-group giving a negative light to surgery. I am here with a positive story.

I am glad my parents made the decision to “put me under the knife”. The only mistake they made was doing it too young. My parents educated me well about it from the moment I could talk. The nurses and doctors were also very open and helpful.

In 1974 I was born with severe perineo-scrotal hypospadias and chordee. The corona was attached at the perineum and the phallus divided the scrotum into two parts with a testicle on each side. The meatus was peritoneal, anterior to the anus.

I was first seen by Dr. Edward S. Tank, an associate professor of surgery in pediatric urology at the Oregon Health Sciences University, in 1975. Tank’s policy was to wait until four years of age for a staged reconstruction. My parents felt that I psychologically needed the repair done prior to that, so they found a plastic surgeon, a Dr. Melvin, that was willing to do the procedure. He attempted a one-stage procedure. This was done at age 2 and was a failure. I was left with a discontinuity between my perineal urethral opening and the end of the neourethra, which ended at about mid shaft. The phallus was foreshortened and buried with ventral cutaneous scarring. I had to sit to urinate.

My parents returned to Dr. Tank and he proceeded to set things right. In 1979 I was given a tube graft, made from a full thickness skin graft taken from the left groin and hip. The penis was freed up from the scrotum and subcutaneous tissue. A tunnel was made through the scrotum exiting 4mm away from the previous perineal hypospadias. The tube graft was brought up through the tunnel and between the corporeal bodies. The corporal bodies were then buried in the mons pubis and an incision was made around the mons pubis to bring two skin flaps around the penis. The chances for success were predicted at around 50%, before the surgery. It was successful.

Over the course of the next two years I had two dilatations of the urethral tube and three urethroplasty surgeries before the neourethra and native perineal meatus were successfully joined. In the process infections occurred, fistulas developed, and hair grew in the urethra. In 1983 a scrotal abscess developed which had to be incised and drained, yielding ~10 cc. of purulent material.

In 1986 I went in for a penoplasty with translocation of the scrotum. This was decided after several months of depotestosterone injections made little change in the size of the phallus. The phallus was foreshortened with a diminished amount of dorsal penile skin that seemed to tether the penis. The scrotum extended up laterally and superiorly to the penis. During surgery these scrotal wings were developed as flaps, and translocated inferior to the penis. The skin on the ventral surface of the penis was mobilized below the corona, buttonholed, and then translocated to the dorsum of the penis to add skin length to the dorsal aspect of the penis. A meatoplasty was also performed with closure of two glans wings on each side of the meatus. About three years later I went in for a final surgery to remove hairs growing in my urethra.

My current status is an erection length between 3″ and 4″ (8-10 cm) and an erection circumference ranging from a maximum of about 6″ (15 cm) at the base and a minimum of about 5″ (13 cm) just below the corona. I have an erection that points slightly downward, a good urine stream most of the time, hair still growing in the urethra, hair growing on the outside of the shaft, an extremely sensitive penis, scarring, and frequent urinary tract infections. I have never had any problem getting an erection; however, due to the high sensitivity of the penis I have to put much more effort into controlling ejaculation. I also get sore very easily during long, vigorous intercourse. Intercourse is often painful, both during and afterwards. The pain is primarily in the urethra and is a burning sensation, like a UTI. The first time I have intercourse with a woman without using a condom, I almost invariably get a UTI (unless I am careful about evacuating the bladder immediately afterwards and drinking lots of water).

I know for a fact that I am fertile. As far as I know, there is no history of hypospadias in my family. I am glad my parents had it corrected, I only regret that they did not listen to Dr. Tank. The first surgeon they took me to was a plastic surgeon, not even a urologist. Tank was able to correct both what the first surgeon had messed up, and what was messed up in the first place. Tank specialized in pediatric urology, had been doing it for years, and worked at a the pre-eminent facility in the state for medical care and research. The fact is, my situation got better and better with each surgery. My advice to someone who plans to get their child surgery is; wait until the child is at least 4 years of age and make sure you get the very best surgeon. That surgeon should be a pediatric urologist, not a plastic surgeon. The biggest mistake is to make a rash decision.

I have been with many women and most are accepting of what I have, especially if they care about me. There are those who will reject, but that is part of dating no matter who you are. You have to be willing to suffer if you want anything out of life. Just remember to work on your skills as a good lover (especially tongue skills). I have been with women who detested me and women who adored me. Just be careful not to dwell on the problem too much, that can be a turn-off for some women. Whatever you do, DO NOT BE AFRAID OF RIDICULE. Most women will not ridicule you. In addition, there are other things to live for besides sex. Sex is a fleeting gratification that does not bring lasting satisfaction.

To the parents of HS kids; don’t be afraid to make a judgement call. I do not resent my parents at all for putting me through the surgeries, in fact, I would resent them if they hadn’t. Also, educate them about it from the moment they are able to talk. They should know the facts from the very beginning, and chances are, it will boost their intelligence. I knew I was different from the very beginning. At age five I knew what my best friend looked like. I had to sit to pee until I was five, fortunately this was corrected shortly before I started kindergarten. I was able to stand up and pee in the urinals like all the other boys, but 5 and 6 year-old boys tend to look at each other’s penises and I got some flack from the other boys about my small size.

Around the time of my last surgery, at 14, I decided I wanted to test out my plumbing so I lost my virginity with the girl that all the boys in the neighborhood lost their virginity with. She was very caring and fun and made me feel good and comfortable about sex. I found out that my plumbing worked and became much more confident as a human being. I began feeling comfortable with both men and women. I am generally not very open with people about my condition, but I am that way with every aspect of my life. I have found that the few people I have told, both men and women, have been accepting.

I don’t want to speak for anyone who has one of the milder hereditary forms of hypospadias, but for those with the more severe forms, which are possibly environmental, it is almost imperative that surgery be done. Just be cautious about who you go to.