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urology

Hypospadias

Hypospadias is a congenital condition in males where the opening of the urethra is not located at the tip of the penis. Instead, the urethral opening can be found anywhere along the underside of the penis, from just below the tip to the scrotum. It’s one of the most common genital abnormalities in boys, affecting about 1 in every 200 to 300 live male births.

Causes

The exact cause of hypospadias is not fully understood, but it is believed to involve a combination of genetic, hormonal, and environmental factors. The condition occurs when the urethra does not develop fully during fetal growth. Risk factors may include maternal age, exposure to certain environmental toxins, and family history of the condition.

Symptoms

The primary symptom of hypospadias is the abnormal positioning of the urethral opening. Depending on the severity of the condition, symptoms may include:

The urethral opening located along the underside of the penis rather than at the tip.
A downward curve of the penis, known as chordee.
A hooded appearance of the penis because the foreskin is not fully developed on the underside.
Difficulty with urination, such as spraying or having to sit down to urinate.

Diagnosis

Hypospadias is usually diagnosed shortly after birth during a physical examination. The condition can vary in severity, generally classified based on where the urethral opening is located and whether there is associated curvature of the penis.

Treatment

Treatment for hypospadias involves surgery to correct the position of the urethral opening, straighten the shaft of the penis if necessary, and, if required, modify the foreskin to achieve a more typical appearance. The surgery is usually recommended before the child reaches 18 months of age but can vary based on the individual case and the severity of the condition.

Surgical repair aims to achieve functional and cosmetic improvements, including enabling the child to urinate standing up and ensuring a normal appearance of the penis. The success of the surgery generally is high, and complications are rare but can include issues such as fistula formation (an abnormal connection that allows urine to leak), scarring, and the need for additional surgery.

Aftercare and Outlook

Postoperative care is crucial for a successful recovery. This may involve pain management, ensuring the surgical site is clean and protected, and possibly using a catheter temporarily. Most children recover fully from surgery and go on to have normal urinary and reproductive function.

Parents of children with hypospadias are encouraged to follow up with their healthcare provider for monitoring and to address any concerns or complications promptly. With proper treatment, the outlook for children with hypospadias is excellent.