Repair of a urethral opening on the underside of the penis, with straightening of the shaft, usually in a single operation in infancy.
In hypospadias the opening of the urethra lies on the underside of the penis rather than at the tip. It is present from birth and is often accompanied by a downward bend and a hooded foreskin. Surgery moves the opening to the tip and straightens the shaft, usually in one operation in infancy, and in more severe forms in two stages.
Three features usually occur together: the urethral opening is in the wrong place, the foreskin is incomplete and hooded rather than encircling, and the shaft may bend downward, which surgeons call chordee. Severity is described by where the opening sits. In most children it is near the tip or just below it, and these distal forms are the most common and the most straightforward to correct. In a minority the opening lies at the middle of the shaft, or further back towards the scrotum, and those proximal forms are considerably more complex.
One practical point matters more than any other before the first consultation. The foreskin should not be removed, because the tissue used to rebuild the urethra is very often taken from it. A circumcision carried out before the condition is recognised does not make repair impossible, but it removes the most useful material and complicates the reconstruction.
If a boy has hypospadias together with an undescended testis, he is assessed further before surgery, because that combination can point to an underlying hormonal or genetic condition that should be identified first.
Repair is usually carried out between six and eighteen months. At that age the child is fit for anaesthesia, tissue heals well, and the operation is done before he is old enough to remember it or to be aware of the difference. It is not an emergency, and delay to allow proper assessment is reasonable.
In distal hypospadias the urethra is generally extended to the tip in a single operation, the shaft straightened, and the glans and skin reconstructed around it. In proximal cases with significant bending, the repair is more often staged: the shaft is straightened and tissue laid in at the first operation, and the urethra is formed at a second, six months or so later. Which route is taken is decided on the table as much as beforehand, and parents are told both possibilities in advance.
A fine catheter or stent is usually left in place for roughly a week to two weeks to divert urine while the repair heals, along with a dressing. Most children go home within a day or two with the catheter in place, and parents are taught how to manage it.
At home the main tasks are keeping the catheter draining, giving pain relief and antibiotics as prescribed, and keeping the area clean. Bladder spasms are common while the catheter is in and are treated. Double nappies are often used in infants. Once the catheter is out, the stream is watched: it should be single and forward.
The recognised complications are worth knowing before consenting rather than after. A small opening can form where the repair heals imperfectly, letting urine escape lower down; this is the commonest problem and is closed at a separate operation, usually after at least six months. The new opening can narrow, the glans repair can partly separate, and the urethra can develop a stricture later. Rates differ sharply between distal and proximal repairs, and an honest figure for a particular child can only be given after examining him.
Follow up continues past infancy, and ideally into and beyond puberty, because the stream, the shape of the penis and any late narrowing are all judged on a grown organ rather than an infant one.
| Factor | What it covers |
|---|---|
| Severity and position of the opening | Distal repairs are shorter than proximal ones |
| Single stage or staged | Proximal cases often need two operations months apart |
| Degree of bending | Correcting significant chordee adds to the reconstruction |
| Paediatric anaesthesia | Anaesthesia and monitoring for an infant |
| Catheter and dressings | A stent stays in for roughly one to two weeks |
| Hospital stay | Usually a day or two for a distal repair |
| Any secondary procedure | Closure of a fistula or release of a narrowing |
These pages answer the questions that most often come up alongside this one.
It depends chiefly on whether the repair is distal or proximal and whether it is done in one stage or two. An estimate covering surgery, paediatric anaesthesia, the catheter and dressings, hospital stay and follow up is given once the child has been examined.
Usually between six and eighteen months. The child is fit for anaesthesia, healing is good, and the operation is behind him before he is aware of it. It is not urgent, and taking time to assess a complex case properly is better than operating early.
No. The foreskin is very often the tissue used to rebuild the urethra, so circumcision before repair removes what the surgeon needs. If a religious or family circumcision is planned, say so at the first visit and it will be discussed.
That is one of the aims of the operation, along with a straight shaft and a single forward stream. Most boys achieve it after a successful repair, and the result is judged over the following months rather than in the first week.
Usually about one to two weeks. Parents are shown how to look after it before going home, and bladder spasms while it is in place are common and treatable.
A small leak where the repair has healed imperfectly is the commonest complication. It is closed at a separate, smaller operation, generally after waiting at least six months so that the tissues have fully settled. It does not mean the first repair has to be undone.
Hypospadias itself does not usually affect the ability to father children. Severe untreated bending can affect sexual function in adult life, which is one reason straightening the shaft is part of the operation. Where hypospadias occurs with undescended testes, fertility is assessed as part of that wider condition rather than as a consequence of the repair.
Cover for congenital conditions varies between policies and some apply a waiting period. The hospital team assists with pre-authorisation and documentation, and cover is confirmed with the insurer before the date is fixed.
Published with written patient consent and shown for education rather than promotion. Every case is different and these images are not a promise of results.
Consultations at Kiran Hospital, Katargam, Surat. Outstation and NRI patients can request a video consultation before travelling.