The main function of the penis is to carry urine and sperm out of the body. The urethra is the tube that urine flows through out of the bladder. The opening of the urethra is at the end of penis which is called meatus or pee- hole that is partly covered by the foreskin. Most of the boys are born with normal working penis but some boys has a birth defect (congenital condition) of the male urethra called hypospadias in which the meatus or pee-hole is anywhere along the underside of the penis instead at the penis tip. This can cause problems with erections and while passing urine. Hypospadias can be of different types depending on severity of the problem and location of the opening of the urethra:
• Subcoronal – the opening of the urethra is located somewhere near the head of the penis
• Midshaft – the opening of the urethra located along the shaft of the penis
• Penoscrotal – the opening of the urethra located where the scrotum and penis meet.
A man can sometimes have a curved penis in hypospadias and may have problems with abnormal spraying of urine or might have to sit to urinate. He may also have to face sexual problems like performing intercourse, erection dysfunction etc later stages in life. Some other problems likely to occur in untreated hypospadias may include:
• Abnormal appearance of the penis
• Abnormal curvature of the penis
• Impaired ejaculation
• Physiological problems
• Mild erection difficulties
The exact cause of hypospadias is not known, it can be genetic or environmental. The development of the penis during the growth of the baby in the womb (uterus) is partly dependent on the male sex hormones like testosterones and when a malfunction occurs in the action of these hormones causes the urethra to develop abnormally.
Hypospadias can be noticed at the time of birth and can be diagnosed by physically examining the penis. Doctor will refer the patient to a surgeon who specializes in genital and urinary conditions for further evaluation and based on its symptoms can provide expert treatment. Treatment of hypospadias depends on the type of the defect person has. Some of hypospadias are very minor and may not require surgery. But in most of the cases, a person may need surgery to correct the defect in hypospadias.
Surgery is usually done between the ages of 6 to 12 months to reposition the urethral opening, circumcising the foreskin, making urinary channel and if required, straighten the shaft of the penis. This complete procedure can take 90 minutes to 3 hour approx. The repair generally last a lifetime and will also be able to adjust as the penis grows at puberty. In most of the cases, hypospadias can be corrected in a single surgery that is performed as an outpatient. Some types of hypospadias may require more than one surgery to correct the defect.
Most of the time, this surgery is very successful. The penis looks normal after surgery and person may have normal urination and reproduction. But sometimes, a hole can develop underside of the penis where the urinary channel was created resulting in urine leakage. Scars can also from in the urine channel or in the urethral opening which can interfere with passing urine. This may require an additional surgery for repair. Patient may require regular follow up to check for healing and possible complications.