One of the important congenital disorders in baby boys is hypospadias, in which the opening of the urethra is lower than its normal position, on the shaft of the penis. If a newborn looks as if he was born circumcised, this condition should be suspected. The condition has a wide range, from very mild to very severe, in which it may be difficult to tell the baby's sex. What problems occur if it is not corrected?
- Your child cannot pass urine standing up
- He has narrowing of the urethra
- The penis looks curved and abnormal
- Urinary infection may occur
- In adulthood he cannot have sexual intercourse, and fertility will be affected.
Risk factors are factors that make a baby more likely to have hypospadias. They include: the mother being older; the baby being conceived by IVF.
Signs of hypospadias: hypospadias is easily diagnosed by a doctor, but as a guide for parents, it can cause the following signs: the urethral opening is lower than normal; the penis bends downwards; urine sprays when passing urine; half of the foreskin is missing, i.e. the baby looks as if he has been partly circumcised.
Treatment: this condition is treated with surgery, and the operations range from simple surgery, like circumcision, to complex operations. In severe cases several operations are needed, and the penis will never look completely normal. In cases where hypospadias is very mild and the urethral opening is a few millimetres lower, on the head of the penis, no treatment is needed.
There are many surgical techniques for each degree of hypospadias; depending on the patient's condition and the surgeon's experience, the right operation is chosen after discussion with the family. The best age for surgery is between three months and one year.
Important points before surgery: do not have your child circumcised before the operation, because the foreskin is used to repair the defect. The operation should definitely be done before the age of one. The operation, or the first operation, involves making a new urethra from the tissues at the site and joining it to the normal position; this is very delicate, microscopic surgery.
Education for parents – 1: to prevent injury to the operation site, your child's movements will be restricted; also, to stop sheets and blankets pressing on the area, you can use a bed cradle.
- To reduce your child's restlessness, a sedative is used as advised by the doctor
- After the operation, keep your child lying on his back in bed for one to five days and reduce his activity so that he rests completely.
- To prevent constipation (hard stools) caused by long bed rest, encourage your child to have fluids and high-fibre foods such as carrots, lettuce, vegetables, etc. Also, drinking enough fluids and keeping the urine flowing helps keep the passages open
- If there is very little urine or you notice any change in passing urine, tell the doctor or nurse.
- Drink enough fluids.
- Use a shower (not a bath).
- Empty the urine bag promptly so that it does not become heavy and put pressure on the urethra.
- The dressing on the operation site must stay in place for at least four days after the operation and must not be removed; when it is taken off, the dressing must be thoroughly soaked.
- The swelling and abnormal shape go away gradually over months.
Prepared by: Azam Tirafkan – Education Unit
Document code: NO-BR-46