Definition:
Surgery to repair a birth defect of the male urination tube (urethra). The normal
male urethral opening is at the tip or end of the penis. A defect in which the urethral
opening is on the underside of the penis instead of on the tip is called a hypospadias.
Hypospadias may be a mild defect (with the urethral opening slightly out of place, near
the tip of the penis) or severe (with the urethral opening farther up the shaft of the
penis). Hypospadias frequently includes a shortening or bending under of the penis.
Description:
Surgical repair of hypospadias is done using general anesthesia (i.e., you are
asleep.) The type of repair depends on the severity of the defect. Mild defects may
be repaired in a single procedure, while severe defects may require two or more
procedures.
The males circumcised foreskin is used to create a tube to extend the urethral length to
allow placement of the urethral opening at the tip of the penis. Circumcision should NOT
be performed at birth on infants with hypospaidas so that the foreskin can be used for the
repair. Hypospadias repair kills two birds with one stone
- getting rid of the hypospadias and properly circumcising the male.
Indications:
Hypospadias is one of the most common birth defects seen in infant boys. Surgery
is necessary to allow normal urination, to correct the penis deformity, and to ensure
normal sexual functioning. The repair and circumcision should be performed before the
child reaches school age.
Expectations after surgery:
Outcome is good following surgical repair.
Convalescence:
Immediately after surgery, the penis is securely taped to the abdomen to for
stability. Medications may be given to relieve pain. The child is encouraged to take
fluids to maintain urine output to avoid pressure on the urethra. Hospitalization is
usually 2 to 3 days. Lots of fluids and frequent urination should continue after release
from the hospital. Strenuous activity should be avoided until the surgical repair is fully
healed.
Risks:
Risks for any anesthesia are:
*reactions to medications
*problems breathing
Risks for any surgery are:
*bleeding
*infection
The most common complication is swelling of the penis which usually resolves within a few
days.
Costs:
The costs of any surgery varies significantly between surgeons, medical
facilities, and regions of the country. Patients who need more extensive surgery will
require more intensive and expensive treatment.
Surgery charges can be separated into five parts: 1) the surgeon's fee, 2) the
anesthesiologist's fee, 3) the hospital charges, which includes nursing care and the
operating room, 4) the medications, and 5) additional charges.
1. Surgeon's fee: averages $650 to $1800
2. Anesthesiologist's fee: averages $350 to $400 per hour
3. Hospital charges: basic rate averages $1,500 to $1,800 per day
4. Medication charges: $200 to $400
5. Additional charges: assisting surgeon, treatment of complications, diagnostic
procedures (such as blood or X-ray exams), medical supplies, or equipment use.
Insurance coverage for surgery expenses depends on many factors, although this procedure
is usually covered under most medical insurance programs.
A Personal Account
The location and size of my urethral opening (under my glans, rather than at its end) has made my life difficult. At a friend's house, I would have to sit down to pee (my spray is too irregular to stand), and sometimes I would still make a mess. Either on the floor or myself and have to "explain" how I spilled so much water on my pants (to cover up the wet pee spots) or clean up the bathroom floor with toilet paper (and thus occupy the bathroom for quite a while). In public, I used to avoid drinking fluids so I could wait to go at home, but when I did I was always very self-conscious and unable to use a urinal without messing up my clothes.
I'm not comfortable telling too much about my sex life, but I can say that my Hypospadias hasn't always made things the most convenient. My foreskin resembles a hood (no foreskin or frenulum on the ventral surface) and the uneven pull has resulted in some painful tearing during intercourse. I have spoken with my boyfriend (I am gay and in a monogamous relationship) and he says that he will support any decision I make regarding my penis (he is uncircumcised).
For the uninformed (most everyone), surgical correction of my Hypospadias will use a portion of my foreskin to replace the missing urethra, locate my peehole in the usual place, and remove my remaining foreskin (leaving me circumcised; low and moderately tight because my foreskin is short already).
I have seen two urologists in favor of correcting my Hypospadias. I am in favor of getting it fixed, but nervous all the same. Reading the messages in this list has given me new courage to pursue this. It is my penis, and I have a right to pee upright! I really want to have the hypospadias corrected! It's affecting my life and sex life adversely.
Repair of hypospadiasis is quite a major operation. In serious cases, where the urethral opening is near the base of the penis (and often there is substantial chordee as well) it it pretty much inevitable that it must be repaired if the patient is to be able to conceive children - not to mention being able to urinate without discomfort. But the case shown in Christiaan's pix is a mild case - it isn't entirely clear but I suspect there may even have been a partial repair. Many doctors would feel that the risks outweighed the benefits in attempting to repair such a minor example. And many repair operations in the past didn't take the reconstruction any further than the base of the glans anyway since that fulfilled most needs without cutting up the glans itself. It would be interesting to know if the other pictures did in fact provide enough detail to see if in fact this was a partial repair or a mild hypo.
James Badger (CA, AUS)
Some time ago there was a long discussion about the birth defect known as hypospadias. This is a condition where the urethral opening occurs other than in it's normal position at the tip of the glans. People with this condition most commonly have a urethra which terminates just short of the glans, in the area of the cleft on the under side, however the urethral opening can also occur at any point on the under side of the penis from the glans all the way to the perenium.
Not to long ago I was down loading some pics and noticed that the model obviously had an uncorrected hypospadias with a urethral opening which terminated in the area of the cleft on the underside of his glans. I am including three pics from the series for everyone's interest.
Often RIC is deferred in these cases because the foreskin is sometimes used to construct an extension for the urethra and the foreskin is most often not joined on the bottom side of the glans. Clicking and enlarging this area on your viewer will show that in the area of his opening - which is directly in the path of the normal frenulum, in his case the frenulum divided around his urethral opening.
I've also included a head on (no pun intended please) shot which shows the cleft in his glans but without the urethral opening in the normal position. Obviously the young man isn't self conscious about his condition and it doesn't affect him sexually as the last of the series shows him masturbating.
Christiaan
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Repair of hypospadiasis is quite a major operation. In serious cases, where the urethral opening is near the base of the penis (and often there is substantial chordee as well) it it pretty much inevitable that it must be repaired if the patient is to be able to conceive children - not to mention being able to urinate without discomfort. But the case shown in Christiaan's pix is a mild case - it isn't entirely clear but I suspect there may even have been a partial repair. Many doctors would feel that the risks outweighed the benefits in attempting to repair such a minor example. And many repair operations in the past didn't take the reconstruction any futher than the base of the glans anyway since that fulfilled most needs without cutting up the glans itself. It would be interesting to know if the other pictures did in fact provide enough detail to see if in fact this was a partial repair or a mild hypo.
James Badger (CA, AUS)
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