The treatment for hypospadias is surgery. There are over 200 published techniques and surgical procedures that correct hypospadias and it isn’t possible to delve into much detail here. The need for surgery ranges from optional in the mild forms, to becoming necessary to allow function in the more severe cases. Each case of hypospadias must be evaluated on its own merits. Frequently, chordee must be corrected before hypospadias can be addressed, since chordee can affect the degree of hypospadias. While single stage surgeries are becoming more routine, it is likely that a two-stage procedure will be chosen in cases of severe chordee, or severe hypospadias and chordee. Chordee repair will occur in the first stage, and typically six months later a second surgery is scheduled to revise the location of the urinary opening.
HEA recommendations regarding surgery:
- Do not rush into a decision. Hypospadias is not life threatening and will not change or get worse in time. There is no emergency, and no need for haste. Take your time.
- Gather as much information as you need to make a decision you are comfortable with. Choose a surgeon who is familiar with the degree of hypospadias you or your child has, and one who has experience in that severity of hypospadias.
- Parents should consider delaying surgery until the child is old enough to take part in decision making.
- Adults should seek out specialists in adult hypospadias repair, or revision of childhood surgeries. Pediatric hypospadias repair is not the same as adult surgery. Adult hypospadias repair is a recognized specialty in urology. In addition, some plastic surgeons specialize in hypospadias repair and re-repair.
- Ensure that you communicate your expectations of the outcome to the surgeon and that you understand that certain things are possible and others are not. For years the standard of care was to create a straight erection for intercourse and a good stream to allow urination while standing. Cosmetics were not given a high priority. This is changing and the appearance of the penis after repair is good with modern surgeries. What cannot be done is to create a penis that is larger than it was to begin with. While the penis may appear longer after chordee repair, it is simply a straightening of the penis the patient had to begin with.
- Consider doing nothing. Surgery always leads to scarring, which can develop into strictures, which can require further surgery to repair. Surgery always leads to a loss of some sensation. This loss of sensation may range from slight to highly problematic. Surgery frequently involves loss of some tissue (even when tissue from the foreskin, buccal mucosa, or other areas is added to re-form problematic structures). Repeated surgeries on the penis can mean loss of more and more tissue, which in some cases can mean reduction or loss of function.
by Douglas J