Hypospadias is the most common congenital genital defect requiring early surgery. Surgical treatments like hypospadias repair are changing gradually, often repeating treatment strategies used decades ago. Historically, the two-step process has been replaced by a one-step process, and more recently, the two-step process has seen renewed interest. The same applies to reconstruction with urethral plates, which were still based on the Thiersch-Duplay principle decades ago. While foreskin flaps were most commonly used in the 1980s, today, there is renewed interest in using urethral plates.
What is hypospadias repairing?
Hypospadias repairing is a surgery that corrects a defect in the penis opening present at birth. The urethra (the tube carrying urine outside the body from the bladder) does not end at the tip of the penis. Instead, it ends at the base of the penis. In more severe cases, the urethra opens in the middle or end of the penis or in or behind the scrotum.
Doctors perform hypospadias repairing between the age of 6 months and two years. Surgery is performed on an outpatient basis. Children rarely have to spend the night in the hospital. Boys with hypospadias should not be circumcised at birth. To repair the hypospadias during surgery, surgeons may need extra tissue from the foreskin.
How is hypospadias repairing surgery performed?
The child will be given general anesthesia before surgery. As a result, the baby will fall asleep and not experience any pain. Doctors can repair minor defects in one operation. The surgeon uses the foreskin or a small piece of tissue from another site to create a tube that extends the length of the urethra. The lengthening of the urethra allows it to open at the tip of the penis.
During surgery, the surgeon may insert a catheter (tube) into the urethra to help it maintain its new shape. The catheter can be sewn or attached to the penis head to keep it in place. It will be removed 1-2 weeks after surgery. Most stitches used during surgery dissolve naturally and need not be removed afterward. In addition to the abnormal opening of the urethra, boys born with hypospadias may have an underdeveloped foreskin (the skin at the end of the penis), and the penis may appear curved.
Hypospadias Repair operations typically include the following steps:
- Create the remaining unformed urethra or tube to the end of the penis.
- The urethral meatus moves towards the end of the penis.
- Penile shaft correction if the penis is curved.
- Circumcision (removal) of the abnormal foreskin of the penis.
Some complicated cases of hypospadias may require more extensive surgical repair.
After hypospadias repair surgery
- Doctors continuously monitor heart rate, blood pressure, temperature, and oxygen levels while the child sleeps.
- The child may wear a breathing tube while sleeping. A breathing tube can cause the child to have a sore throat after surgery.
- An anesthetic can be administered through a mask, IV lines, or both to keep the child asleep during surgery. Once the surgery is over, the medication is stopped, and the child begins to wake up. Once the child is moved to the recovery room, parents will be called to attend when they wake up.
- The doctor who performed the surgery will meet the parents to discuss the surgery and answer any questions.
- Tail anesthesia allows the child to wake up comfortably without surgical pain.
- Children must remain in the recovery room for supervision until they wake up and have stable vital signs. The amount of time the child spends in the recovery room varies. It is because some children take longer to wake up from general anesthesia.
Quick Facts About Hypospadias Repairing
- Hypospadias repair is surgery that corrects the position of the penile orifice when it is not in the proper place at the end of the penis.
- The surgery is performed under general anesthesia. It means that the child will be asleep during the operation.
- The child will also be given a tail anesthetic to reduce pain in the area below the waist.
- A pediatric urologist, an expert in pediatric urinary and reproductive surgery, repairs the child’s hypospadias.
- This surgery lasts 1-2 hours.
Conclusion
Hypospadias repair is a major surgery, but it is essential to perform. With proper care and rest, the child recovers super soon. A child is born with this condition. Doctors recommend surgery between 6 and 24 months. Parents have the right to choose when to have surgery.
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