Hypospadias is a congenital abnormality, also known colloquially as "prophetic circumcision." This condition is characterized by the presence of a urinary opening at the base of the penis instead of the normal one at the tip. Initial surgical intervention is crucial for treatment because it helps prevent lifelong problems. However, if the initial surgery is unsuccessful, the risk of complications from a second corrective surgery can increase. Therefore, it is important that hypospadias surgery be performed by experienced pediatric surgeons. Hypospadias, in addition to the urinary opening being located in a different location than normal, can sometimes present as a double opening. Additional symptoms such as a bent penis and a retained foreskin may also be observed.

What are the causes of hypospadias disease?

Hypospadias is a congenital abnormality. While the exact cause is not yet known, various factors are thought to be involved. These factors include certain hormones and medications the mother is exposed to during pregnancy, advanced pregnancy, in vitro fertilization (IVF), identical twins, and prematurity. These factors may increase the risk of hypospadias.

How is hypospadias diagnosed?

Hypospadias is usually detected by pediatricians during the first postnatal checkups, or when mothers notice the absence of the foreskin on the underside of the penis, the urinary meatus being located under the penis, and a forward curvature of the penis while changing their baby's diaper. A diagnosis of hypospadias is confirmed by an examination by a pediatric surgeon.

What preparations need to be made before hypospadias surgery?

• Examination and diagnosis: First of all, the patient must be examined and diagnosed by a pediatric surgeon for hypospadias.
• Blood tests: Blood tests should be performed before surgery. These tests are performed to assess the patient's general health and determine any risks associated with the surgery.
• Anesthesia approval: Since anesthesia is required for the surgery, the patient must be evaluated and approved by the anesthesiologist.
• Diet: Patients are asked to abstain from liquids for 4 hours and solids for 6 hours prior to surgery. This is essential to prevent potential complications during surgery and ensure a comfortable postoperative recovery.
• Pre-operative information: The patient and their family are given detailed information about the surgical process, as well as post-operative care and recovery.

These precautions are important for a successful surgery and recovery process by ensuring the patient is best prepared before hypospadias surgery.

How many hours does hypospadias surgery take?

The duration of hypospadias surgery varies depending on the type of condition and the surgeon's experience. For patients with mild distal hypospadias, surgery can typically take approximately 1-1.5 hours. However, in more severe cases or with complications, surgery may take longer.

Is hypospadias surgery necessary? What are the possible consequences if surgery is not performed?

Hypospadias surgery is important and often necessary for physical, social, and psychological health. Without hypospadias surgery, the patient may experience the following potential complications:

• Urinary problems: Individuals with hypospadias may experience problems such as urine being directed toward the base of the penis and leaking. This can interfere with daily life and cause discomfort.
• Aesthetic problems: The appearance of the penis can be affected by hypospadias. Conditions such as the absence of the foreskin and the abnormal shape of the glans can be aesthetically distressing and can particularly affect school-aged children.
• Curvature problems: In some cases of hypospadias, penile curvature can occur. This can affect sexual function and intercourse.
• Risk of infertility: Especially in severe cases of hypospadias, the risk of infertility may increase during adulthood.

For these reasons, surgery is often recommended for patients with hypospadias. Surgery can help resolve these issues and improve the patient's quality of life.

Is hypospadias a familial disease?

Hypospadias is thought to be inherited in families. At least 10% of cases are familial, and a family history of hypospadias increases the likelihood of developing it in other children. The prevalence of hypospadias is particularly high in societies where consanguineous marriages are common. If a father has hypospadias, the risk of their child developing the condition is higher than in the general population.

Why is hypospadias not circumcised?

Because hypospadias is a congenital anomaly of the penis, circumcision does not address the underlying problems and may even exacerbate them. In hypospadias, the urinary meatus at the tip of the penis is not in its normal location, and circumcision can result in an incision made outside of this natural location. This can lead to uncontrolled urine flow or further aesthetic and functional problems in the penis. Therefore, treatment for hypospadias usually requires surgery, and circumcision can be performed as part of the surgical procedure at an appropriate time after surgery. However, circumcision itself is not a treatment for hypospadias, and surgical planning and careful evaluation are necessary if a person with hypospadias is circumcised. Therefore, hypospadias is not a reason for circumcision, and circumcision alone is not sufficient to treat the condition.

Is hypospadias dangerous?

Hypospadias is generally not a life-threatening condition, but it can lead to various complications and affect a patient's quality of life. These complications can include urinary tract infections, urine leakage, sexual dysfunction, aesthetic concerns, and psychosocial difficulties. Treatment for hypospadias usually involves surgery, and if not timely or appropriately treated, it can lead to long-term problems. However, with modern surgical techniques and early diagnosis, these problems can largely be resolved. Therefore, while it is important to treat hypospadias, it does not pose an immediate medical risk.

At what age is hypospadias surgery performed?

The ideal time for hypospadias surgery is generally between 6 months and 1 year of age. In particularly severe cases, it is recommended that the first surgery be performed before the child turns 1 year old, and the second surgery before the child turns 2. Early intervention is crucial for better outcomes and to reduce the risk of complications.

Who is affected by hypospadias?

Hypospadias is a congenital urological abnormality that occurs in males. It is not specific to any ethnicity, geographic region, or socioeconomic group, meaning it can occur in any boy. However, certain risk factors may increase the likelihood of developing hypospadias. These risk factors may include:

• Family history: Hypospadias is thought to run in families. A child with a family history of hypospadias may be more likely to develop the condition in their siblings.
• Maternal age: Advanced maternal age may increase the risk of hypospadias.
• Drugs and chemicals: Use of certain drugs and chemicals during pregnancy may increase the risk of hypospadias.
• Maternal smoking and alcohol use: Maternal smoking or alcohol use may increase the risk of developing hypospadias.
• Environmental factors exposure during pregnancy: Environmental factors exposure during pregnancy may affect the risk of hypospadias.

While the exact cause of hypospadias is unknown, it is thought to be the result of the interaction of multiple genetic and environmental factors. Therefore, hypospadias can occur in any child, but the risk may increase in the presence of certain risk factors.

Is there any harm if hypospadias surgery is delayed?

Yes, delaying hypospadias surgery can lead to various risks and negative outcomes. Potential harms of delayed hypospadias surgery include:

• Wound healing process: Postponing surgery may prolong the wound healing process and delay the patient's return to normal activities.
• Risk of infection: Delaying surgery can increase the risk of infection. Urinary tract infections, in particular, can cause serious postoperative complications.
• Trauma and psychological impact: Hypospadias is a condition that can affect children's social and psychological health. Delaying surgery can increase the stress and anxiety experienced by the child.
• Catheter problems: Prolonged use of a catheter during surgery can cause discomfort and pain for children. Older children may be reluctant to have the catheter removed, which can affect surgical outcomes.

For these reasons, it's recommended that hypospadias surgery be performed as early as possible, usually before age 1. Early surgery reduces the risk of complications and can help the patient have a better recovery.