The most common malformation of the male genitalia is called hypospadias. The term hypospadias is derived from the Greek words hypo (under, too little) and spadon (tear, groove). It is characterized by three features, the occurrence of which, however, is highly variable.

The urethral opening (meatus) is not at the tip of the glans, but in the lighter forms opens at the level of the coronary sulcus. However, the further the urethral opening is from the tip of the penis, the more complex the malformation. In extreme (and fortunately rare) cases, the urethra can be so severely shortened that its opening lies at the transition to the scrotum or even in the area of the pelvic floor. In these cases, there may also be a disorder of sexual differentiation (development), which must first be examined and ruled out.

The second feature concerns the foreskin, which is not closed in a circle around the glans in hypospadias. Instead, it lies on the glans like a kind of skin flap and can also be firmly adhered to it. The glans also appears rather flat with a more or less pronounced curvature.

Curvature of the penis shaft. Here, too, the shape is very variable. In mild forms, the curvature is limited to the glans, whereas in more pronounced findings, the entire penis is extremely shortened and distorted.

In most cases, hypospadias is an isolated malformation of the penis that can be corrected surgically. Hypospadias is usually always corrected surgically. Even if there are no problems with urination (micturition) and sexuality and fertility are not impaired in mild forms, there is rarely any doubt about the need for surgery. This is because it is still a feature that should not be underestimated that a boy or man can "urinate forward" in the stream. This is not possible with hypospadias and it is not only the downward urine stream that causes a variety of problems for those affected. In order to spare children these often humiliating experiences (e.g. "urinating on their shoes"), the 2nd year of life is chosen as a good time for correction. This applies to the most common and mild form of hypospadias, which accounts for around 80% of patients. The remaining 20% of the approximately 30 new hypospadias patients we treat each year are more severe and sometimes extreme forms that require a highly individualized treatment concept (see below). This consultation takes place in a personal discussion with the responsible pediatric urologist.

The first contact and consultation should take place as early as possible in our pediatric urology consultation. Parents can then find out about the disease itself and the treatment options in good time.

For mild forms of hypospadias and otherwise healthy children, we do not require extensive preliminary examinations. In more pronounced forms, a detailed diagnosis must be made, as the changes in the penis may be part of a disorder of sexual differentiation (development). In these cases, we involve an MHH-based interdisciplinary team, which offers patients a comprehensive examination (genetics, hormones, etc.) as well as detailed advice and care. In complex forms or special cases, the first visit to the pediatric urology consultation should take place as early as possible so that the necessary additional examinations can be initiated in good time.

 

 

Mild forms of hypospadias
We follow a defined standard for the treatment of mild and therefore common forms of hypospadias. Before the actual operation, we look at the findings in our consultation hours, explain to the families exactly what we propose to do next and arrange an operation date. For mild forms of hypospadias, we can perform the procedure under general anesthesia the day after admission to hospital.
We always correct the mild form of hypospadias using the same technique (a modified operation according to "Snodgrass" and "Thiersch-Duplay"). This involves constructing the urethra with tissue from the glans and penile skin and covering it with tissue from the foreskin. This means that the foreskin must be completely removed during this procedure. During the operation, a small catheter is left in the newly formed urethra. At the end of the procedure, we wrap a loose bandage around the penis. The bandage and catheter are usually left in place for 3 days. If the little patient is then micturating without any symptoms, nothing stands in the way of discharge.

Complex forms of hypospadias
More pronounced forms of hypospadias cannot be operated on using a standard procedure, but require an individualized treatment concept. The extent of the diagnosis and the surgical procedure depend, among other things, on the length of the urethra to be reconstructed and the anatomical changes in the genitals.

The catheter that splints the new urethra and the bandage are removed on the 3rd day after the operation in mild forms and the children can urinate on their own again. The children also need antibiotic protection and sometimes pain medication is also necessary. If urination is painless the next morning, the patient is discharged. Stitches do not need to be removed as they dissolve themselves.

In complex forms, the newly formed urethra is usually splinted with the catheter for a week. However, this time can be changed in any direction. This depends on the treatment plan that we draw up with the parents before the procedure.

An outpatient check-up is scheduled approximately 6 weeks and 6 months after the operation. If there are no complications in the first few months, it can usually be assumed that the operation will be successful for the rest of the patient's life, including normal development of the penis during puberty.