What is Hypospadias (Half Circumcision)?

It is a congenital disease of the penis, the male sexual organ. Hypospadias is a congenital shortening of the urinary duct in the penis and the end of the duct opening somewhere on the underside of the penis. Because the foreskin is also missing on the underside, these children are also called “half-circumcised”. In severe types, there is a downward curvature (curvature) in the penis that becomes evident especially during erection, the child has difficulty urinating standing up, the appearance of the genitalia is not normal, sometimes even resembling the female genitalia.

What is the cause of hypospadias and how often is it seen?

It occurs in every 300 live male births. The cause is mostly unknown. Hormonal foods are also blamed for the increase in the incidence in recent years.

Is Hypospadias a Familial Disease?

If the father and siblings have hypospadias, the incidence in other siblings is higher than normal. However, we cannot say that it is definitely familial or genetically inherited.

Are There Types of Hypospadias?

Yes, there are. There are many types depending on the location and curvature of the willy opening. But in general

1. Mild (Distal) Hypospadias

   

    

2. Midshaft Hypospadias

   

    

3. It can be classified as proximal (penoscrotal) or severe hypospadias.

   

    

How is Hypospadias Diagnosed?

Examination is sufficient for diagnosis and should be recognized at birth. In most cases, no additional examination is required. The level at which the urinary canal opens on the underside of the penis is important for the type and success of surgery.

Are there any findings of hypospadias other than the penis hole not being in its normal place?

Yes, there are; there may be findings such as flattening of the glans penis, absence of foreskin (prepusium) on the underside of the glans penis (congenital half circumcision), curling of the penis downward when the penis hardens, i.e. cordi, scrotal transposition, bifid scrotum.

Can Hypospadias be accompanied by other diseases?

Generally, distal and middle types of hypospadias do not have other diseases. However, proximal hypospadias may be accompanied by undescended testicle, curvature of the penis - Cordi, kidney, urinary excretory duct and bladder problems. For this reason, in severe types, evaluation with ultrasonography and sometimes biochemistry tests may be required after diagnosis.

Especially in proximal hypospadias, if the testicles are not palpable on both sides, careful evaluation for anomalies of sexual development is necessary.

Should Children with Hypospadias be Circumcised?

Since foreskin (prepusium) is used in many types of hypospadias to form the missing urinary canal, this precious material should not be wasted by circumcision. In other words, circumcision should never be performed.

How is hypospadias treated?

Today, there are different surgical methods according to the type of hypospadias. This period is expected to benefit from the rapid growth of the penis in the first 6 months of life. Considering that the period between 2.5-6 years of age is not psychologically appropriate, the surgery should be performed at a young age and the child who will begin to recognize his sexual organs at this age should not remember the sexual organ disease at all. Therefore, the surgery should be completed before the age of 2. Contrary to popular belief, the fact that the baby uses diapers is more advantageous in many ways. For all these reasons, the recommended age of surgery is between 6 months and 1 year.

Although it is decreasing today, a common mistake is the unconscious circumcision of these children. This makes the treatment difficult. Because foreskin is often used in the treatment. In the surgery, the short urinary canal is lengthened, brought to the tip of the penis and the curvature, if any, is corrected. While the penis is normalized with surgical treatment, circumcision is performed simultaneously.

 

 

The choice of surgical method depends on the severity of the disease. The surgery is performed under general anesthesia. Depending on the surgical method, the operation takes approximately 1.5-2 hours. During the surgery, a catheter (catheter probe) is inserted into the newly formed urinary canal to drain the urine, and the patient can be discharged with this catheter a few hours after the surgery. This catheter is removed on average 5-7 days after the operation. No anesthesia is required for catheter removal. There is no dressing after the operation. However, the patient may need to lie down during the catheterization.

The surgical treatment of this disease has some features, and interventions performed by inexperienced people who are not accustomed to the characteristics of the child patient and the child's body and who have not received adequate training on these issues can lead to complications that are difficult to correct (such as curvature of the penis, stenosis in the newly formed urinary canal, urine leakage, poor cosmetic appearance, repeated surgery and psychological problems).

What happens if hypospadias is not operated?

It varies depending on the location of the hypospadias on the penis, but there may be problems in using the toilet properly, as well as problems during erection due to the curvature of the penis in adulthood.

What are the Risks of Hypospadias Surgery?

As with all surgeries performed with general anesthesia, there are risks related to anesthesia, which you will be informed about by anesthesiologists before surgery.

Risks related to the surgery are; bleeding, wound infection, stenosis at the mea tip, fistula, opening of the sutures and recurrence, probe-related discomforts that occur as long as the catheter is attached.

 

Fistula appearance due to hypospadias surgery

Is a second operation necessary in hypospadias?

It may be necessary in severe types. Again, in all types, reoperations may be required due to complications such as stenosis, fistula, recurrence and diverticulum.

Will this condition affect fertility and sexual life in the future?

If left unoperated, such problems may be encountered, especially in severe types of hypospadias. However, these risks are eliminated after successful surgery.

Will hypospadias occur in my next children?

We cannot say for sure, but the risk is slightly higher compared to other children.

What is done before hypospadias surgery?

First of all, a good history should be taken and a general physical examination should be performed, not just an examination of the groin area and a systemic examination should be performed. Then, the family (mother and father) should be well informed about the process, i.e. before, during and after the operation. If the child is older, the child is also included. A number of tests are performed, these tests are not general and are determined according to the patient. The patient is also seen by the anesthesiologist and the family and child are informed about the anesthesia process. The patient is fasted for 4 hours before surgery.

How long does hypospadias surgery take?

This is related to the degree of hypospadias. However, it can be generally accepted as 1.5-2 hours, but this can be much longer in severe hypospadias.

*** If you see a deformity in your child's penis, consult a physician. Even if only the foreskin seems to be missing, do not circumcise your child without consulting a specialist in pediatric surgery!

*** The information provided here is intended to inform the visitor about the content of the website. No information should be considered as advice by visitors and should not lead to any decision or action. Families related to the subject should have their patient examined by a pediatric surgery specialist, consult with him/her and make a decision by consulting his/her knowledge one-on-one.