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| Name | Top 7 things which Pediatrician must know about Hypospadias- Dr A.K.Singal/Dr Ashwitha Shenoy |
| Video Uploader | Video From Pediatric Urology & Hypospadias Channel |
| Upload Date | This Video Uploaded At 20-11-2023 06:53:28 |
| Video Discription | Top 7 things which Paediatrician must know about Hypospadias After the child is born the pediatrician will usually examine the child from head to toe for any external anomalies. In a normal male neonate, glans is covered by the foreskin and prepuce is complete. Hypospadias is very evident in a newborn due to ventrally incomplete prepuce, visible glans and a urinary opening on the underside of penis. The pediatrician should also check the presence of testis in the scrotum. If the testis is not palpable in the scrotum in presence of hypospadias, further evaluation for a disorder of sex development (DSD) should be carried out. Some of the children with severe hypospadias may also have a very small phallus which may look like a clitoris. If the child has Hypospadias with undescended testis, severe hypospadias, or hypospadias with a microphallus, then we need evaluation for DSD. A thorough evaluation is necessary before planning the definitive management in DSD. The treatment plan is formulated only once we arrive at a diagnosis. In addition to a pediatric urologist opinion, the child is also referred to a pediatric endocrinologist for hormonal evaluation. Typical tests for DSD include Karyotyping, hormonal tests and maybe an MRI scan of the pelvis to check for female internal genitalia. If the child has isolated hypospadias, without suspicion of DSD, it is wise to refer the parents to visit a pediatric urologist before 6 months of age. Typical evaluation and counselling are best done at this age. This also gives time to the family to prepare for surgery. In children with suspected DSD, referral to a pediatric urologist should be done in the newborn age itself. The pediatric urologist will check the position of the meatus, size of penis, assess the degree of chordee and the location of testis. In children who are born full term, have a good weight, no major associated anomalies and are thriving well, the best age for hypospadias surgery is around 9-12 months but definitely before 18 months of age. We recommend surgery between 9-12 months of age because it is easier to manage the child in the post-operative period, healing is excellent in infants. The second-best age will be from 3-5 years of age. In children who are born pre-term, have failure to thrive or associated anomalies, it is better to operate between 3-5 years of age when other issues are sorted out. This gives us the best chance to give safe anesthesia and ensure good recovery. Surgery for hypospadias is done under general anesthesia along with caudal analgesia. The type of surgery for hypospadias depends upon the degree of hypospadias and degree of chordee. Chordee correction or the straightening of penis remains the single most important step in hypospadias repair. In cases of mid, distal and proximal penile hypospadias, if the chordee is less than 30-degree, surgery can be done in a single stage. If the chordee is more than 30 degrees, then we need to do staged repair. The minimum gap between the two stages is 6 months. Most of the children with severe hypospadias such as penoscrotal, scrotal and perineal hypospadias, need a staged repair for long term good outcomes. The success rate of hypospadias surgery at our center is above 95%. The most common complications which we encounter are fistula formation, diverticulum formation, meatal stenosis or rarely wound infection, an additional surgery may be required in some of these complications. Successful results in hypospadias are a culmination of experience and a correct choice of technique. Even after this a small number of children may have a complication but that’s not the end of the world. In most of these cases even after a suboptimal result a good outcome can be achieved in expert hands with second surgery. Most of the children or adults will have normal fertility once they have achieved good outcomes with hypospadias surgery. Only in children with undescended testis or a Disorder of sex development there are chances of infertility. Uncorrected hypospadias or a failed Hypospadias surgery can cause male infertility due to various reasons. It may be due to abnormal location of the meatus, diverticulum, stricture or presence of chordee. The altered or narrow opening of the urethra can cause problems in ejaculation, hence causing infertility. Presence of chordee can make sexual intercourse difficult or painful. The severity of hypospadias and the success of surgical repair will ultimately decide fertility. Hence it is important that an expert surgeon performs the hypospadias surgery, and a long-term follow-up is maintained. In cases of hypospadias, proper evaluation, preparation and a sound surgical technique is important for good outcomes. It is also important that first surgery is done at a centre where there is a large amount of experience and dedication to genital surgeries in children. Fortunately, science and advances in surgery have made it possible to have excellent outcomes. |
| Category | Education |
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