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Frequently Asked Questions (FAQs)
Can genetic factors contribute to the likelihood of hypospadias?
In approximately 7 percent of sufferers, the father is also affected. The chance that a second son will be born with hypospadias is about 12 percent. If both father and brother are affected, the risk in a second boy increases to 21 percent.
Is it necessary to correct distal hypospadias?
- Many parents ask if surgery is needed for mild degrees of hypospadias. While it is difficult to predict problems later in life by evaluating an infant, there are several valid reasons for recommending routine correction, regardless of the severity.
- First, as many as 15 percent of boys with this condition will have a noticeable downward curvature, a chordee, that may interfere with his ability to achieve an effective erection in adulthood.
- Second, while the urethral opening may be in a nearly correct position, it is often misshapen or enlarged. Or it may have a web of skin just behind the opening. Those factors can disturb the urinary stream. Consequently some boys will notice spraying to the sides or a downward deflection. The penis functions but these problems can be embarrassing.
- Similarly, a partially formed foreskin that is not corrected will always appear abnormal, even resembling the hood of a cobra, which can call unwanted attention to the defect. Any potential problem must be weighed against the likelihood of a successful surgery. But most pediatric urologists today recommend the procedure for all but the most minor degrees of hypospadias.
What kind of anesthesia is used? Is it safe to put infants to sleep?
Hypospadias repair is done while the patient is asleep, under general anesthesia. Many anesthesiologists also administer nerve blocks near the penis or in the back to minimize discomfort when the child awakens after the operation. These forms of anesthesia are very safe, especially when given by anesthesiologists who specialize in the care of children. Today, it is considered safe to do surgeries such as hypospadias repair in otherwise healthy infants.
Which repair is best?
The procedure will depend on a number of factors, including the degree of hypospadias and extent of penile curvature. Since the surgeon will not be able to analyze the situation until the operation is underway, he or she must be familiar with a range of approaches. What may appear as an easily repaired distal hypospadias may turn out, on closer examination, to be a more complex problem. Consequently, pediatric and reconstructive urologists with special training and expertise with this condition perform hypospadias repair.
How do I care for the wound after surgery? How long will the healing take?
- Studies consistently show that hypospadias repair wounds do not require special attention to heal properly. While the surgeon can choose from several types of bandages, he or she may not apply any at all. You will receive specific instructions regarding bandages and routine bathing.
- If your child has a catheter, it may be left to drain into diapers, which can be changed as usual. If the patient is older, it will be connected to a bag, which you will learn how to empty. Catheters are usually kept in place for five days to two weeks.
- Wound healing from a hypospadias repair begins immediately, and lasts for many months. Early on there may be swelling and bruising, which improves over a few weeks. Sometimes the skin of the penis heals with an unsightly bump or there are complications. Recommendations for additional surgery will not be made for at least six months, allowing the tissues to recover. Many slight imperfections will resolve during this time.
If there are problems after several operations, can hypospadias still be repaired?
- Yes. Fortunately, the majority of operations are successful the first time. Yet, a few patients require re-operation because of complications. Most of them will have a good outcome the second time, while a few will have lingering problems leading to even more surgery. This small group of patients is sometimes referred to as "hypospadias cripples," implying that their problems cannot be fixed.
- While it is difficult to consider more surgery in these unusual circumstances, there are options available that offer hope for success. For example, scarring from prior operations can be removed and replaced with fresh tissue from other areas, most often from inside the cheek, to create a urinary channel and still achieve good cosmetic results
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