Overview
Hypospadias is a congenital condition present at birth in some baby boys, in which the urethral opening sits somewhere lower on the penis instead of at its natural position at the tip. It occurs in roughly 1 in every 200 male births, and is fully treatable surgically with very high success rates when performed at the right age by a specialist surgeon.
The condition typically involves three elements: a mispositioned urethral opening, an incompletely formed foreskin on the underside (sometimes informally called a “hooded foreskin”), and occasionally a downward curvature of the penis known medically as chordee. Not all three elements are necessarily present, or present to the same degree, in every case — a specialist examination is needed to determine the exact grade.
Grades of Hypospadias
Hypospadias is classified by the position of the urethral opening into three main grades:
- Anterior (mild) grade — the most common, representing about 70% of cases. The opening is close to or just below the tip of the penis, and is treated in a single surgery with excellent results.
- Middle (moderate) grade — the opening is on the mid-shaft of the penis, always requires surgery, and may need a somewhat more complex technique than the mild grade.
- Posterior (severe) grade — the opening is at the base of the penis or near the scrotum. The least common and most complex grade, often requiring a two-stage surgery and a surgeon with specific expertise.
Important note: if a circumcision doctor stops the procedure and refers you to a pediatric surgeon, that is entirely the right call — the foreskin is an important tissue used later in the repair, and cutting it incorrectly beforehand can complicate treatment.
Pre-Op
After the diagnosis is confirmed, the child is prepared for surgery under full general anesthesia. It is very important to follow these points before the surgery date:
Don't proceed with circumcision before evaluation
If a circumcision doctor stops the procedure and asks you to see a pediatric surgeon, that's the correct call — the foreskin is used in building the new urethra, and cutting it beforehand can complicate the surgery.
Determining the severity grade
The surgeon examines the child to determine the hypospadias grade (anterior/middle/posterior) and whether any curvature (chordee) is present, since this determines whether one or two surgical stages are needed.
Full general anesthesia
The surgery is performed under full general anesthesia, taking 1 to 3 hours depending on the severity of the case.
Best surgical timing
International medical consensus recommends surgery between 6 and 18 months of age, when caring for the child is easier and he has no psychological awareness of the condition.
Post-Op
Hypospadias surgery is an essential step toward improving the penis's appearance and ensuring the child urinates normally for life. Below is what happens after surgery, how to care for the wound, and the expected recovery period.
Immediately After Surgery
The child is moved to the recovery room, where he is closely monitored until the effects of general anesthesia wear off — drowsiness and dizziness for a while are normal. Mild swelling or redness at the surgical site is expected, along with a few drops of blood in the urine during the first few days, with some pain managed by doctor-prescribed painkillers.
Recovery Period
Recovery typically takes 2 to 4 weeks, varying based on the child’s condition and how much correction was needed during surgery — more complex cases (posterior/severe grade) may take longer to heal.
Signs of a Successful Surgery
- No urine leakage anywhere else on the penis — urine exits only from the new opening.
- Improved urine flow without difficulty or pain.
- No complications or infection, such as fever or urethral narrowing.
- Normal wound healing without pus or persistent severe redness.
- Pain gradually disappearing, with the child comfortable moving around.
- The doctor confirming no issues during regular follow-up visits.
Possible Complications
Rare when an experienced pediatric surgeon performs the repair, and include: urine leakage (urinary fistula), narrowing of the new urethra from scar tissue, rare minor shape irregularities, infection at the surgical site, wound bleeding, or the desired outcome not being fully achieved (requiring a second surgical intervention).
Wound Care
- Keep the surgical area clean per the doctor’s instructions.
- Avoid touching the wound or pulling on the surrounding skin.
- Change dressings regularly if any are applied.
- Make sure the catheter stays properly positioned without being pulled or shifted.
Symptoms Requiring Immediate Medical Attention
- Significant redness or increasing swelling of the penis.
- The child’s temperature rising above 38°C.
- Urine leaking from an abnormal location.
- Severe pain or difficulty urinating.
- A foul odor from the surgical site, or a blocked catheter with no urine flow.
Frequently Asked Questions
What is hypospadias repair surgery in children?
Hypospadias repair corrects a congenital condition present in some baby boys at birth, in which the urethral opening sits on the underside of the penis instead of at its tip. The surgery repositions the urethral opening correctly and corrects any downward curvature of the penis (chordee).
When is hypospadias surgery recommended?
Surgeons recommend performing the surgery when the child is between 6 and 18 months old, provided he has not already undergone circumcision.
How long does hypospadias surgery take?
The surgery usually takes about an hour or slightly more, depending on how complex the case is. Milder (anterior) cases take less time than more complex cases where the urethral opening is closer to the base of the penis.
How long is recovery after hypospadias surgery?
Recovery typically takes two to four weeks for the tissue to fully heal. The child usually stays in hospital for a day or two after surgery, with follow-up continuing afterward in clinic.
What is the success rate of hypospadias surgery?
Success rates reach 90-95% when the surgery is performed by an experienced, specialized pediatric surgeon.
What complications can occur after hypospadias surgery?
Rare complications include urethral stricture from scar tissue, urine leakage (fistula), and wound infection. Regular follow-up with the surgeon significantly reduces these risks.
What symptoms after surgery should prompt a visit to the doctor?
See the doctor immediately if you notice: bleeding, abnormal discharge from the wound, fever, difficulty urinating after catheter removal, or increasing redness and swelling around the surgical site.
Book Your Consultation Now
Last updated: December 4, 2024