Most hypospadias repairs are performed in childhood, but some cases require treatment later in life. When this happens, the complication rate can be high.
This surgical procedure can be performed under general anesthesia. Mild defects may be repaired in one surgery, but severe hypospadias can require multiple surgeries to correct.
What to Expect
Typically, the wounds from hypospadias repair do not need any special care. The urethral catheter may be left in place. This can drain pee directly into diapers or be connected to a bag. The health care provider will instruct you on how to empty the catheter. Usually, the urethral catheter is left in place for 5 days to 2 weeks.
Boys with uncorrected hypospadias have a hole in the penis and have trouble passing urine normally. This can cause embarrassing problems. It can also lead to psychological issues in adulthood.
Hypospadias repairs in adolescents and adults have lower success rates than those performed in infants. Because of this, it is important to see a surgeon with experience treating hypospadias in teens and adults. Many healthcare providers have a specialty team dedicated to hypospadias surgery for adults. These specialists can ensure that the surgery is successful and reduce future complications. They can also help patients find the best support.
In infants, hypospadias is rarely a problem, but as boys grow into adults, it can cause problems with erectile function and create a hole (fistula) on the underside of the penis. A surgical procedure can correct these issues by creating a normal excreting urethra and improving penile cosmesis.
A primary repair of hypospadias during childhood is associated with high success rates, but some patients develop late complications such as urethrocutaneous fistula, persistent curvature, urethral stricture or urethral diverticulum. This group of patients is difficult to treat and can present a therapeutic challenge to the surgeon.
After a successful surgery, the stent is removed in the office and the wound heals quickly, although it may take up to a year for the tissue to completely heal. There will be swelling and bruising at first, but this gets better over time. It is important to keep follow-up appointments so that the healthcare provider can monitor healing and prevent any future complications.
In severe forms of hypospadias, the urethra may curve downward and interfere with erection. In these cases, boys need surgery to straighten their penis. In some cases, this is even recommended for mild types of hypospadias to prevent problems in adulthood.
Most distal adolescent and adult hypospadias repairs are successful. However, a few patients develop complications later in life. These include urethral fistulae, meatal stenosis, urethral strictures and a persistent chordee (hairy urethra).
Those who undergo hypospadias repair as children may need to undergo more surgeries to fix these problems as they grow into teens and adults. Some studies have shown that these complications can cause problems with urination, cosmetic appearance and sexual function.
When an adolescent or adult is diagnosed with a hypospadias complication, it’s important to see a surgeon who specializes in this condition. This can help ensure the best results and improve the patient’s quality of life. A surgical specialist will also be able to handle any additional procedures that are needed to correct the complications.
Modern hypospadias repair results in a penis that works well and looks normal (or nearly so). In some older children, teenagers and adults, surgeons leave a tube (“catheter” or “stent”) in the urethra for a few days to keep urine from touching the fresh surgical wound. You will be taught how to care for the catheter and change it as needed.
You may see a little swelling or bruising in the area after surgery, but this improves over the first 6 weeks. The bandages will likely turn red from the normal oozing of blood, but do not be concerned about this.
A very small number of patients who had a hypospadias repair as a child develop late complications such as a urethral stricture decades after the initial surgery. These patients often have few voiding complaints and can be managed by performing a perineal urethrostomy using buccal mucosal grafts.