The Outcome of Pediatric Hypospadias Repair in Adulthood

Hypospadias is a rare condition, where the baby is born with the urethra not located at the tip of the penis. It affects 1 in every 200 newborn boys. This is usually fixed with Pediatric Hypospadias Repair by 18 months of age.

Types of Hypospadias:

  • Distal – external opening is located close to the head of the penis
  • Midshaft – opening is near the middle shaft of the penis
  • Proximal – opening is close to the scrotum

Pediatric Hypospadias Repair

There are four things that take place during Pediatric Hypospadias Repair:

  1. Straighten the shaft
  2. Make the urinary channel
  3. Position the hole in the head of the penis
  4. Circumcise the foreskin

Symptoms Of Repair Complications

  • Testicle pain on either side
  • Weakness or pain urinating
  • Straining to empty bladder
  • Hard spots in the penis
  • Urinary Tract Infections
  • Sexual discomfort

Complications After Surgery

Strictures – The most common complication is urethral stricture disease. The stricture is when the urethra narrows and causes stream pressure to slow when voiding. It’ll also put pressure on systems located behind the structure. If things back up, it causes problems for the bladder, prostate, kidneys and testicles.

Strictures might be the result of scar tissue buildup in the urethra. Possibly from the foreign tissue that was used to recreate it. The tissue might not have good blood flow or it’s not responding properly to sex hormones.

The answer is to dilate the urethra. However, just dilating the urethra will re-traumatize the already scarred tissue. So, it will have to be a total re-repair.

Fistulas – A customer has a hole that you’re in town come out of below the urinary opening. If everything has healed properly, this is an easy fix.

Glans Dehiscence (Partial Wound Breakdown) – This is when the head of the penis that was wrapped around the urinal opening comes apart. It will cause the urethral opening to move down. The surgeon will redo it by moving the opening back to the normal position and re-wrapping the head around it.

Meatus Stenosis – Scarring at the new urethral opening that causes blockage. It occurs when a male has symptoms like not being able to void or a urinary tract infection and has a smaller opening.

Diverticulum – A visible ballooning during urination of the urinary channel. Usually, there’s dribbling after urination.

Penis Curvature – Persistent bending can be caused by the original bending not being correctly fixed during surgery. The only way to properly correct the problem is re-repair.

Hair Growth – Sometimes hair bearing skin was used to rebuild the penis. After puberty, hair will begin to grow and can cause urinary tract infections. A laser can be used if there are only a few hairs. If there are a lot of hair, a re-repair will need to be done with non-hair bearing skin.

Skin Scars – Some surgeons choose to use penis skin to make the urine channel, while others don’t. All repairs involve cutting into the skin of the penis, but should be made in natural skin lines. It’s extremely important that no scars are left on top of the penis, to be seen daily by the patient.

Sometimes there’s so much scarring that the skin needs to be replaced by a skin graft.

Psychological Consideration – Not only are functional and physical concerns involved with Hypospadias, but psychological concerns too.

Patients and parents can have stress, anxiety, depression and shame.

Parents have no reason to feel guilty for this happening, it was nothing they did. The decision to fix the problem is a necessity, even if it didn’t turn out like they had hoped.

Patients have no reason for shame, it was something they are born with.

If the psychological concerns become a serious problem, they should see a licensed professional.

Re-repairs

Most re-repairs are single surgeries, but some are done in two stages. Re-repairs have a higher risk for complications than do first surgeries.

Comments are closed.

Search