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ISSN 0973 - 0958
Genital Problems in
Children
Absence of Testis from
Scrotum
Circumcision in Children
Acute Swelling and Pain
in Scrotal Region
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HYPOSPADIAS IN CHILDREN
Continued...
The ideal age for surgery is 1½ years of age. A number of surgical operations have been described - all of them have a common goal i.e use of the thin skin of the penis and the prepeuce to form the new urethral tube and join it to the already present urethra to bring the opening to the tip of the penis. This is a very delicate surgery and takes 2 - 3 hours.
The ideal age for surgery is 1½ years of age. A number of surgical operations have been described - all of them have a common goal i.e use of the thin skin of the penis and the prepeuce to form the new urethral tube and join it to the already present urethra to bring the opening to the tip of the penis. This is a very delicate surgery and takes 2 - 3 hours.
It requires fine sutures and magnification for doing it perfectly. The type of operation depends on where the original opening is; the nearer the tip, less complicated is the surgery.In cases with a chordee, the choice is to do a two stage surgery with correction of chordee in the first stage and then 6 months later a second stage with reconstruction of the urethral tube and bringing it to the tip of penis. The alternative is a one stage surgery in which both correction of the chordee and reconstruction of the urethra is done in one stage. The choice of operation depends on technical considerations and the experience and training of the surgeon. A tube or catheter is kept thru the urethra in the bladder that drains urine directly into a uro bag for 7 days to allow the sutures to heal without getting wet. After 7 days, the tube is removed and the boy is asked to pass urine from the new tip opening.
Complications following this operation are possible in 20% of the boys. The most common is called Fistula. After the reconstruction - urine must flow from the tip of the penis, but there may be an additional hole that develops from the site of the original opening from which urine escapes - this is a fistula. The reason is simple, the urethral tube that is already present is thick spongy; the tube made by the surgeon is thin skin of the penis. The junction of the two tubes sutured together with very fine sutures is always a weak area and can tear with the force of the urine coming out from the urethra giving rise to a fistula. This is not a life threatening complication , but it needs to be corrected after a wait of 6 months for the local tissues to become supple once again. At times a small leak that occurs may gradually close on its own and no surgery is required to close it. The other complication due to healing and contraction at the tip to cause a narrowing leading to a tiny urinary stream called meatal stenosis. This needs a correction by dilatation of the meatus and the stream will improve. A similar process occurs at the junction of the original tube and the skin tube where a stricture occurs and the stream narrows - again dilatation is required to increase the lumen size of the urethra.
The entire urethra will grow with the child as a whole and there will be no further surgery required when the child grows into an adult.
Post operative results after a few months with meatus at the tip
Last Updated: 27th January 2009
Genital Problems Specialist
Answer
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