Hypospadias
Hypospadias is the most common congenital developmental condition affecting the penis and urethra. The urethral opening is located in an abnormal position, anywhere along the underside of the penis, on the scrotum or even on the perineum. The foreskin is also usually abnormal and has a split, hooded appearance because the tissue on the underside is missing. The frenulum is generally absent. The farther the urethral opening lies from the tip of the penis, the greater the likelihood that penile curvature will also be present. Associated problems may include an abnormal urinary stream, inability to urinate while standing, sexual dysfunction, penile curvature, painful erections, reduced fertility, smaller penile size, cosmetic concerns, undescended testes, inguinal hernia, emotional distress, shame, behavioural difficulties and reduced quality of life.
During surgery, the penis is straightened if curvature is present, the urethra is reconstructed and the urethral opening is placed at the tip of the glans. The glans, surrounding skin and, where necessary, the scrotum are also reconstructed to achieve a more natural appearance. The long-term aim is to enable satisfactory sexual function, urination while standing and an acceptable aesthetic result. Many surgical techniques are available. Repair is often performed in childhood, but adults may also present for treatment. In some cases, several previous operations have failed and persistent hypospadias, urethral fistulae or other complications have substantially reduced quality of life. Such cases may require highly complex reconstructive surgery.
Failed hypospadias repair / hypospadias cripple
Although hypospadias is usually repaired during childhood, complications after surgery are not uncommon. The initial result may appear satisfactory, while functional, cosmetic or psychosexual problems emerge during puberty or later in adulthood. If complications develop, further corrective procedures may be required and these also carry risks. The term “hypospadias cripple” has traditionally been used for severely compromised, repeatedly operated cases with poor results and multiple complications. Common adult complications that may require further surgery include urethral stricture, urethral fistulae, urethral diverticulum, hair growth or stone formation within the reconstructed urethra, persistent or recurrent curvature, and cosmetic abnormalities of the skin or glans. Several reconstructive techniques are available, and an individual surgical plan is essential in every case.
Epispadias
Epispadias is a congenital male developmental condition in which the penis is small and usually curves upwards. The glans and foreskin are typically abnormally developed. The urethral opening may be located anywhere on the upper surface of the penis, and more severe forms may be associated with urinary incontinence. Epispadias often occurs together with other developmental abnormalities. Surgical reconstruction is complex and may involve straightening the penis, reconstructing the urethra and urethral opening, and creating the most natural possible genital appearance. Some operations are performed during childhood.
Further information is available on the English-language website of our partner centre.