What is the treatment for hypospadias?

Management of Hypospadias

Surgical correction is the definitive treatment for hypospadias, with the optimal timing being between 6 and 18 months of age. 1, 2

Diagnostic Evaluation

• For patients with proximal hypospadias, especially those with undescended testes, endocrinological evaluation is recommended to exclude disorders of sexual development 3, 1
• Renal and bladder ultrasound should be performed to screen for associated urinary tract anomalies, particularly in cases of posterior (proximal) hypospadias 3
• In cases with moderate to severe hydronephrosis, a voiding cystourethrogram (VCUG) may be indicated to evaluate for vesicoureteral reflux and other urinary tract abnormalities 3

Classification and Surgical Planning

• Hypospadias is classified based on the location of the urethral meatus:
  • Distal (70% of cases): Located on the distal penile shaft, considered mild and not typically associated with other urogenital deformities 1, 2
  • Proximal (30% of cases): More complex cases requiring more extensive evaluation and surgical planning 1, 2

Surgical Treatment

The goal of hypospadias repair is to achieve both cosmetic and functional normality 1. Surgical correction involves five sequential steps:

1. Orthoplasty (penile straightening to correct chordee) 4
2. Urethroplasty (reconstruction of the urethra) 4
3. Meatoplasty and Glanuloplasty (reconstruction of the urethral opening and glans) 4
4. Scrotoplasty (if needed) 4
5. Skin Coverage 4

Surgical Techniques

The choice of surgical technique depends on the severity and location of the hypospadias:

• For distal hypospadias:

  • Meatal Advancement and Glanuloplasty (MAGPI) 5
  • Tubularized Incised Plate (TIP) technique according to Snodgrass 5
  • These techniques are generally single-stage procedures with good outcomes 5

• For proximal hypospadias:

  • Vascularized foreskin flap-plasty 5
  • Two-stage repair techniques for more severe cases 4
  • These more complex repairs may require additional tissue for urethral reconstruction 4

Timing of Surgery

• Current guidelines recommend surgical repair between 6 and 18 months of age 1, 2
• This timing minimizes psychological impact while allowing for adequate tissue size for surgical manipulation 1
• Although hypospadias can be corrected at any age with comparable complication risk and outcomes, early intervention is preferred 1

Potential Complications and Long-term Outcomes

• Urethral surgery for hypospadias has a relatively high complication rate and should be performed by experienced surgeons 5

• Common complications include:

  • Urethrocutaneous fistula (abnormal connection between urethra and skin) 4
  • Meatal stenosis (narrowing of the urethral opening) 4
  • Urethral stricture 4
  • Persistent chordee (curvature) 4

• Long-term issues may include:

  • Lower urinary tract symptoms (occurring twice as often in patients after hypospadias repair) 1
  • Potential psychological and sexual function concerns 1, 2
  • Cosmetic dissatisfaction 1

Follow-up Care

• Regular follow-up is essential to monitor for late complications 1
• Long-term urological surveillance is recommended as complications can develop many years after the initial repair 1, 2
• Psychological support may be beneficial, particularly during adolescence 1

The management of hypospadias requires specialized surgical expertise, with the primary goal being to create a functionally and cosmetically normal penis while minimizing psychological impact on the child 1, 5.