Like many parents of boys, before our son was born, my husband and I had to decide if we were going to have our newborn son circumcised. With the many health and hygiene benefits and commonality of circumcision, this was not a tough decision for us. It was a no-brainer, in fact. We decided that of course our son would be circumcised.
However, our son’s body had different plans in mind. Within twenty-four hours of his beautiful, miraculous birth, we were told by my doctor that a circumcision was temporarily out of the question because he was born with a condition called Hypospadias.
Confusion and fear mixed with our excitement and anxiety. We had never heard of this condition before, and although he was born with a very mild case of Hypospadias, we were frightened to learn that because of the condition our newborn baby boy would not only have to stay uncircumcised for at least eight months but would also have to undergo minor reconstructive surgery of his penis sometime between eight and ten months old.
What is Hypospadias?
Hypospadias is a common birth defect that affects one out of every 200 to 250 boys approximately. It is a congenital condition that occurs before week 20 in gestational age in which the opening of the urethra developed on the underside of the penis, consequently resulting in hooded foreskin-foreskin that does not cover the entire circumference of the penis-and sometimes downward curvature of the penis. The cosmetic impact of the hooded foreskin means that there is not enough skin to correctly perform a circumcision, but the functionality affected by Hypospadias is what is most concerning to doctors.
Because the urethral opening is not placed where it should be, which is in the center of the tip of the head of the penis, this can cause problems in urination and, later in life, excreting semen. Mild cases of Hypospadias in which the urethral opening is developed along the shaft is somewhat near the head are known as distal positioning hypospadias; those where the opening is located farther down the shaft and closer to the scrotum, and sometimes behind the scrotum, are known as proximal Hypospadias. Over 80% of boys born with the condition have distal positioning, and of that 80% approximately 15% are affected by mild curvature of the penis due to the Hypospadias. In boys born with proximal positioning of the urethral opening, 50% are affected by downward curvature. Not only is functionality a problem in this case, but cosmetically it can be embarrassing and even be psychologically damaging to a boy’s self-body image. For more information on distal and proximal hypospadias positioning, visit: http://www.urologyhealth.org/urology/index.cfm?article=130.
How is Hypospadias Treated?
Hypospadias, regardless of the type or severity, is corrected through surgery with the end result of a normal straight penis and a urinary channel that ends centered in the tip of the head of the penis. The surgery process involves four steps: straightening the shaft, creating the urinary channel, correctly positioning the urethral opening, and finally either circumcision or reconstruction of the foreskin. During the surgery, tissue grafts are taken from the child’s foreskin to reconstruct the penis (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002265/).
Depending on the type of Hypospadias, the same-day surgery takes anywhere from one hour (for distal) to three hours (for proximal) to complete.
Hypospadias repair can be performed on a child between three and eighteen months of age, but because he has to be put under anesthesia for surgery, most urology surgeons require waiting until the child is at least eight months old to have the condition corrected.
“If hypospadias is untreated, a boy may have difficulty with toilet training and problems with sexual intercourse in adulthood. Urethral strictures and fistulas may form throughout the boy’s life, requiring surgery” (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002265/).
What Happens After the Surgery?
After the surgery, children are placed on antibiotics and given pain medication to be used as necessary for a few days following the operation. Parents may or may not be instructed to use bandages depending on the extensiveness of the surgery, and most urologists will advise applying a triple antibiotic ointment several times a day and keeping the diaper area as dry as possible, relatively speaking. In more severe cases, a catheter may also be used for five days up to two weeks.
We were lucky that our son only had a very mild form of this condition, which was easily correctable and required little after-care. In our case, no bandages were needed, only triple antibiotic ointment, and we were told not to submerge our son in water until the stitches had dissolved nor allow direct pressure to the area for ten days, which meant no straddling anything or bouncing up and down in his jumperoo! Although he had some swelling and black and blue bruising, which is common after surgery, it was pretty mild. The worst for our little guy seemed to be the noticeable pain he was in the first few times he urinated when the pain medication had worn off, but the worst for Mommy and Daddy was waiting through the longest hour of our life to hear the good news that he had come out of the surgery and the anesthesia in good health.