Hypospadias is when the child’s urination hole is not at the tip of the penis, but under it. The urinary canal is not fully formed in the area between this hole and the tip of the penis. It can be classified differently according to the location of the urethra. These cases, which are located on the head of the penis and are very close to where the normal urinary opening should be, are called “glanular hypospadias”. The ones between the head of the penis and the tip of the body of the penis are called “coronal hypospadias”. Both conditions are generally included in the definition of “distal hypospadias”. This group is the most common in children and has the highest surgical success rate. There are also hypospadias located lower, those with the urinary opening in the middle of the body of the penis are called “midpenile hypospadias” (mid-level hypospadias), those located in the area where the middle part of the penis and the bags meet, even in the area we call the perineum, are called “proximal hypospadias” and their surgical treatment is more difficult. . Most of these patients also have penile curvature and this needs to be corrected with surgery. The only treatment for hypospadias, which occurs in one of every 300 boys, is surgery.
There are approximately 500 types of operations defined in surgical treatment. The main purpose is to bring the urinary hole called the urethra to the tip of the penis. Basically, after creating the urinary canal with stitches, placing a patch on it as a layer strengthens the tissue. In the surgery, the root of the penis is suffocated with a rubber and the skin of the penis is peeled to the root. An artificial erection is then made to the penis. In this way, the presence of penile curvature, called chordee, is investigated. The curvature of the penis must be corrected. Then, the location of the newly created urinary hole is determined and a new urethra is created with absorbable sutures such as 6/0, 7/0 and 8/0 using existing tissues. Depending on the severity of hypospadias, circumcision can be performed together, or the foreskin can be used as a patch. However, the view that circumcision should not be performed together with surgery is not correct, on the contrary, performing circumcision together will save the child from a second surgery. Depending on the condition of the surgery and the degree of your disease, a urinary catheter can be inserted, and this catheter remains for an average of 3-7 days. In patients with proximal hypospadias, where the urethra is far from the normal place, and in patients with severe chordee and short urethra, tissue may need to be taken from different parts of the body (arm or thigh skin, mouth, bladder, fascia in the scrotum) for the normal fulfillment of the urethra. In all three cases, if possible, a new urethral canal is created and a urethral catheter is placed and the operation is completed. In cases where the tissue needs to mature or the mouth of the canal is too far from the normal place, the tissue taken is placed on the penis and maturation is expected, the actual correction process can be postponed to a later date (about 6 months later). A cystostomy catheter can be placed under the umbilicus for drainage instead of the urinary catheter. The success rate of the surgery varies between 60-98% depending on the location of the urinary hole and the degree of penile curvature.
