Basics of hypospadias
Hypospadias is a defect that is commonly found in boys at the time of birth. It affects 1 out of 200 boys. In hypospadias, the urethral opening (meatus) is dislocated from the head of the penis. It is either situated along the shaft or the scrotum.
It is not an inherited disorder, but according to studies, hypospadias tends to occur more often in some families as compared to others.
Hypospadias may range from mild to severe, depending on where the meatus is located. The problems associated with the ailment also result depending on the position of the urethral opening. Some struggle to maintain cleanliness, whereas others may encounter reproductive issues in adulthood.
Mild cases of hypospadias typically do not result in any functional issues and thus do not require correction. Severe cases of the ailment, however, frequently present with complications and require surgical correction.
A condition that often accompanies hypospadias is chordee, which is characterized by the bending of the penis.
Types of hypospadias
Three main variants of hypospadias include:
- Sub-coronal: Urethral opening is located near the head of the penis
- Midshaft: Urethral opening is located near the penis shaft
- Penoscrotal: Urethral opening is located at the meeting point of the penis and the scrotum or on the scrotum.
More than 80% of boys have distal hypospadias. Approximately 15% of the cases report a downward curving penis. Curvature is observed in over 50% of the cases where the penis opening is located more proximally.
Cause of hypospadias
Hypospadias develops between the 9th and 12th week of gestation. The male reproductive organs begin to form near the 5th week of fetal development when the male hormones stimulate the urinary tract and penile skin’s formation. Disturbances in these hormone levels are believed to result in hypospadias.
Although the exact cause behind the condition is still unknown, experts suggest that it may result from one or more reasons.
- Genetics: Hypospadias has a higher likelihood of occurring in boys with a family history of the condition.
- Fertility Treatments: Women who use hormone therapy or supplementary medication before or during pregnancy are more prone to giving birth to boys with the condition.
- Age and Weight of the mother: Overweight women over the age of 35 are said to have a greater chance of birthing boys with hypospadias.
- Environmental Factors: Exposure to pollutants, such as smoke, pesticides, and insecticides, increases the risk of developing hypospadias.
Treatment for hypospadias
Hypospadias can be corrected with surgery, which involves straightening the penis (chordee correction) and creating a urethral extension bringing it to the penis tip. Penile skin tissue is used to create the new urethral extension.
Hypospadias surgery is a normal procedure that is performed when the child is between 6 and 18 months of age. The procedure possesses minimal risk, and the patient is often allowed to go home on the same day.
Surgery is the only viable solution to rectify hypospadias as the condition can make urination difficult. This issue presents both functional and social implications that may contribute to reduced self-esteem.
Chordee must be corrected with the help of surgery as well because an erect penis is necessary to ensure proper sexual function. Chordee, if left untreated, may hinder sexual function in adulthood.
Complications of hypospadias surgery
All surgeries come with a few potential complications. The following are some of the risks that accompany hypospadias and chordee correction.
- Bladder spasms
- Stricture or Stenosis
- Recurrent chordee
The formation of a fistula between the skin and the urinary tract is perhaps the most common complication associated with hypospadias repair surgery. Scarring may occur in the urethral channel or at the penis meatus, which may hinder urination. Scarring may also impair complete wound healing.
Complications associated with hypospadias repair surgery, however, can be remedied with surgery.
Can hypospadias affect fertility and sexual function?
Hypospadias does not result in infertility, nor does it inhibit sexual function. However, men with severe hypospadias may be sterile owing to accompanying testicular issues.
Does hypospadias affect the size of the penis?
Studies in the past noted that hypospadias negatively affected penile length. However, a recent study showed that boys with hypospadias do not have shorter penile lengths than those without the condition.
Another study, published in the Journal of Pediatric Urology, revealed insignificant differences in penile length between the control group (without hypospadias) and the study’s subjects.
The researchers noted that more reliable methods must be developed to measure the penile length in children so that further assessment may be conducted.
The recommended method is to record the stretched penis’ length. However, measuring the length of the penis in such situations can be challenging because it is impossible to stretch the penis of a person suffering from hypospadias due to their curvature and ventral surface hyperplasia.
Measuring the length after surgical correction would introduce an element of bias in the study.
While the penile length may seem shorter in boys with hypospadias owing to their curvature, no concrete relation has been established in this regard. Therefore, to answer the question: no, hypospadias does not affect the size of the penis.
Hypospadias can be easily corrected through surgery. We recommend seeking professional help to address any of your concerns because cases of hypospadias are subject to variation. Consult a pediatric urologist to find the best treatment for your child.