What is the management of hypospadias?

From the Guidelines

Hypospadias management primarily involves surgical correction, typically performed between 6-18 months of age, with the goal of minimizing morbidity, mortality, and improving quality of life. The standard approach is a single-stage repair procedure, with techniques varying based on severity. According to the American Urological Association guideline 1, urethroplasty is the best option for obliterated strictures or strictures associated with hypospadias.

Key Considerations

• Distal hypospadias may require meatal advancement and glanuloplasty (MAGPI) or tubularized incised plate (TIP) urethroplasty
• Proximal or severe cases might need staged repairs or flap techniques
• Preoperative testosterone stimulation may be used to increase penile size and improve tissue quality in cases with small penile size or severe chordee
• Postoperative care includes urinary diversion, antibiotic prophylaxis, and pain management

Postoperative Care and Follow-up

• Parents should watch for complications like bleeding, infection, urethral stricture, or fistula formation
• Long-term follow-up is essential through puberty to monitor urinary function, cosmetic outcomes, and sexual development
• Early intervention is preferred as delayed repair may lead to psychological issues related to genital appearance and function, though some very mild cases with glanular hypospadias and no chordee may not require surgical intervention.

From the Research

Management of Hypospadias

The management of hypospadias involves various surgical techniques to correct the abnormality and achieve a functionally and cosmetically normal penis.

• The goal of surgery is to create a near-normal penis with minimal complications 2, 3.
• Different techniques are used, including the two-stage operation, which involves meatotomy, correction of the chordee, partial splitting of the glans penis, and covering the defect with a pedicle flap from the preputial hood in the first stage, and reconstruction of the glans penis and the urethra in the second stage 2.
• Other techniques include the Duckett, Onlay, free tube, Belt-Fuqua, and Thiersch operations, each with its own success rates and complication rates 3.
• The tubularized incised plate (TIP) urethroplasty is also used to treat proximal hypospadias, with a success rate of 88% and a complication rate of 17.5% 4.

Assessment of Outcome

The outcome of hypospadias surgery is assessed based on several factors, including:

• Complication rate
• Cosmetic appearance of the penis
• Functional outcome (micturition, sexuality)
• Psychological factors such as quality of life and psychosexual life 5
• The use of antibiotic prophylaxis is also an important aspect of hypospadias management, with some studies suggesting that a reduced prophylaxis regimen may be effective in reducing complications without increasing the risk of infection 6

Surgical Techniques

Various surgical techniques are used to treat hypospadias, including:

• Two-stage operation 2
• Duckett, Onlay, free tube, Belt-Fuqua, and Thiersch operations 3
• Tubularized incised plate (TIP) urethroplasty 4
• Each technique has its own advantages and disadvantages, and the choice of technique depends on the severity of the hypospadias and the surgeon's preference.