What is Hypospadias (Congenital Half Circumcision)? How is it treated, are there any risks?

It is a congenital disease of the penis, the male sexual organ. Hypospadias is a congenital shortness of the urinary duct in the penis and the end of the duct opens somewhere on the lower side of the penis. Since the foreskin is also missing on the lower side, these children are also called ‘Half Circumcised’. In severe types, there is a downward curvature (curvature) in the penis, which is especially evident at the time of erection, the child has difficulty in urinating standing up, the appearance of the genitalia is not normal, sometimes even resembling the female genitalia. Hypospadias (congenital half circumcision) is not inherited and has different types.

Hypospadias (half circumcision) is diagnosed by physical examination. There is usually no accompanying congenital anomaly, but kidney anomalies can rarely be found. In addition, severe types can be confused with anomalies of sexual development, so care should be taken.

Children with hypospadias (congenital half circumcision) should not be circumcised because the foreskin (prepusium) must be used during surgery.

How is hypospadias (congenital half circumcision) treated? Today, there are different surgical methods according to the type of hypospadias. This period is waited 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 recognise 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 nappies 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 used most of the time in the treatment. In the operation, the short urinary canal is lengthened, brought to the tip of the penis and the curvature, if any, is corrected. While the penis is normalised with surgical treatment, circumcision is performed simultaneously.

The choice of surgical method depends on the severity of the disease. The operation is performed under general anaesthesia. Although it varies according to the surgical method applied, the operation takes approximately 1.5-2 hours. During the operation, a 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 operation. This catheter is withdrawn approximately 5-7 days after the operation. No anaesthesia is required for catheter removal. There is no dressing after the operation. However, the patient may need to lie down during the catheter stay.

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, 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, diverticulum, fistula, poor cosmetic appearance, repeated surgery and psychological problems).

What happens if hypospadias is not operated? It varies according to 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. 

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