Pediatric hypospadias

What is it?

Congenital malformation in which the urethral meatus does not come out at the apex of the penis, but at any point on the underside of the penis between the glans and scrotum. The more the urethral meatus is located toward the scrotum, the more curved the penis is. The foreskin is incomplete because the underside is missing.

The penis consists of a body called the “shaft” and an end called the “glans”, at the apex of which is the urethral meatus from which urine flows. The glans is covered by a layer of mucous membrane and gliding skin called the “foreskin”.

Causes and risk factors

This disease affects 1 to 8 children out of every 1,000.

Hypospadias is the result of abnormal development of the urethra during intrauterine life. The causes are not known.

Which are the symptoms?

The child is completely asymptomatic. This malformation does not affect the overall health of the child and does not cause problems with urine excretion, except for abnormal direction of the urine stream and, in adulthood, semen.

How is it diagnosed?

The diagnosis is obvious from birth. A specialized examination by a pediatric urologist confirms the abnormality and determines the location of the urethral opening, which may be on the glans, the upper part of the penis, the midsection of the penis, or, less commonly, at the base of the penis or in the scrotum.

By observing the erect penis, you can also determine if it is curved or not. Hypospadias is usually not associated with other urological malformations, so in most cases further examination is not necessary.

Suggested exams

How is it treated?

Treatment is surgical (urethroplasty) and is aimed at:

  • reconstruction of the missing urethra;
  • correction of any curvature of the penis;
  • reconstruction or removal of the foreskin.

The tissues used for reconstruction can be derived from areas adjacent to the urethra, from the foreskin and, in special cases, from the bladder or the labia. However, it is the child’s own tissues that will grow with the child.

The methods and the corresponding difficulties are varied and depend on the length of the urethral canal to be reconstructed. Regardless of the degree of hypospadias, reconstruction of the entire missing urethra in one operation at six months to one year of age is recommended.

The most common postoperative complication is the urethro-cutaneous fistula, a small lateral opening through which urine escapes. The longer the section of the urethra to be reconstructed, the more likely it is. The fistula may resolve spontaneously within 6 months. If not, further surgery is needed.

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