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Hypospadias for parents

Controversies in Hypospadias repair

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What are the ways to assess  success of hypospadias repair?

The success is assessed by clinical examination and parents/child opinion. However the points of view of the patient and the surgeon may differ, especially on cosmetic aspect.  To circumvent these, few scores are proposed like hypospadias objective scoring evaluation (HOSE) system, Pediatric penile perception score (PPPS) or The Hypospadias Objective Penile Evaluation Score (HOPE). However, most of the scores do not consider the severity of the condition and preoperative findings while evaluating the final outcome. 

What is the Ideal age of Hypospadias repair?

  • Treatment of Hypospadias starts with birth of the child, the first and foremost step being to inform and console the parents about the congenital anomaly, timing and outcome of surgical procedures, and establishing a bond of confidence between parents and the surgeon.

  • The timing of surgery is chosen after considering milestones of development, size of penis, child response to surgery, anesthesia risk, and toilet training.

  • Following points are worth noting

    • The infant develops good tolerance to surgery and anesthesia by the age of 6 months.

    • The penile length at 1 year is on an average only 0.8 cm less than at preschool age.

    • The child is well aware about his genitalia and toilet training by the age of 18 months.

  • So the most suitable age for operation of hypospadias is between 6 and 18 months.

  • The American Academy of Pediatrics review suggest that the ideal age for genital surgery is between 6 and 12 months.

  • Others prefer to operate even earlier on an adequate-sized phallus at 4 months of age as healing is quicker with minimal scars and the infant overcomes the stress of surgery easily. 

  • Patients may be operated whenever the child is brought to the hospital after the age of 18 months.

  • The all stages of Hypospadias repair should be completed before school going age, which is 3 years in India

Carbine and Rope

Choosing no surgery for my child?

Image by Jackson Simmer

  • Unfortunately, although there have been some published studies on the topic, there is not much
    information about boys or men with hypospadias who did not undergo surgery. Possible problems for
    them include difficulty aiming their stream into the toilet, needing to sit to pee, and poor self-image
    from knowing that their penis looks different.Some report that they are hesitant to become intimate with a new partner, who might be put off by how their penis looks. On the other hand, people who have had hypospadias surgery can sometimes have the same problems. Men with curvature of the penis, and their sexual partners, may have difficulties with sexual intercourse.

  • Clearly, either not choosing surgery or deciding to have surgery is a decision with consequences.
    Caregivers or patients struggling with this choice may want to seek out a mental health professional or
    other trusted person as a support mechanism to help them through this process

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