Does your little son also have Hypospadias? Don't be afraid of this surgery, let's talk!

It is very normal for a mother or father with a newborn son to feel a little scared and worried when the doctor tells them that there is a slight difference in their son's penis, that the opening where urine comes out is not where it should be. This is what we call 'Hypospadias' in medicine. Since many parents have never heard of this word, hundreds of thousands of questions come to mind, such as is this a serious illness, does surgery need to be performed, and will their son feel pain. So, today we are preparing to answer all these questions in your mind and talk about this condition simply.

Simply put, what is hypospadias?

Okay, let's start from the beginning. Hypospadias is a congenital condition. That is, a small change that occurs when a baby grows in the womb. It is not a disease, it is just a small change that occurs during the development of the body.

Normally, a boy's urine exits the body through a hole at the tip of the penis. We call this hole the meatus. The tube that carries urine, the urethra, ends at this hole.

However, in a baby with hypospadias, the urethral opening is located somewhere else on the underside of the penis, rather than at the tip. There are several types of hypospadias, depending on where it is located:

• Slightly below the head of the penis (Subcoronal): This is the most common and least severe type.
• Midshaft: The urethra is located somewhere in the middle of the length of the penis .
• Penoscrotal: This is the most severe and complex case. The hole is located at the beginning of the penis.

In addition, some children may have a tendency for the penis to bend slightly downward when erect (this is called chordee). All of this will be checked by the doctor and, if necessary, corrected with surgery.

Is this surgery (Hypospadias Repair) really necessary?

This is a question that many parents have: "Can't we just do without surgery?"

In fact, not all cases of hypospadias require surgery. If the urethral opening is very close to the tip of the penis, meaning there is only a slight difference, the child will not have any difficulty urinating or in the future. In such cases, the doctor may not recommend surgery.

However, if the hole is located too low, surgery is very important. There are several main reasons for this:

1. Ease of urination: When the hole is at the bottom, it is difficult for the child to urinate while standing upright. The urine spills downward. This can cause psychological discomfort when the child gets a little older because he cannot urinate while standing like other children.

2. Cleanliness: Since urine is sprayed downwards, it can sometimes run down the legs. This is also an obstacle to cleanliness.

3. Future sexual function: When the child becomes an adult, proper ejaculation is necessary for a successful sexual life. If the urethra is located lower, problems with ejaculation may occur.

This surgery is usually done when the baby is between 6 months and 2 years old . At that age, recovery is faster, and the baby will not even remember it. However, the final decision is up to you, the parents. Talk to the doctor carefully, listen to everything that is on your mind, and make a decision.

What happens before the surgery?

Preparing a child for surgery is a big responsibility for parents. Let's take a look at what happens during this time.

First, you will need to see a pediatric urologist. He will examine your child carefully.

• The child's general health is checked.
• The penis is examined to find the exact location of the urethra.
• You will be asked questions. For example, things like, "How is your son's urine flow? Is it fast? Does it go in one go or does it spill everywhere?"
• A special test (Cystoscopy or Urethrogram) may also be performed to check for other obstructions in the urethra.

The day before surgery, your doctor or nurse will give you clear instructions about when to stop feeding your child. It is very important to follow these instructions exactly. This is because if your child has food in their stomach during anesthesia, they may vomit and choke on it. This can cause serious complications.

How is the surgery done?

This surgery is performed by a team of doctors with expertise in pediatrics.

Before the surgery begins, the anesthesiologist will give the child anesthesia. This means that the child will be completely asleep. So the child will not feel any pain, he will not be conscious, he will not know anything. Don't be afraid of that.

After the child is well-rested, the surgeon begins the operation. The main things that happen here are:

1. Creating a new urethra: The doctor usually takes a small piece of tissue from the foreskin of the penis, shapes it into a tube, and connects it to the existing urethra to lengthen it.

2. Bringing the urethra into place: The elongated urethra is brought to the tip of the penis, creating a new urethral opening (meatus) at the tip of the penis.

3. Straightening the penis: If the child has a downward curve (chordee) in his penis, it will also be straightened during this surgery.

After surgery, a thin plastic tube (catheter or stent) is placed in the newly created urethra to keep it from getting clogged and to allow urine to flow easily. This tube is left in place for 7 to 14 days. Urine continues to drain into the bladder through this tube.

Finally, the wound is closed using dissolvable stitches. These stitches do not need to be cut, and they dissolve on their own after about two weeks. The entire surgery can take about two to three hours.

How do you take care of your son after surgery?

In addition to the success of the surgery, it is also very important to take good care of the child after the surgery.

After the surgery, when the child is brought to the ward, doctors and nurses take care of him until he wakes up from the anesthesia. Usually, he can go home the same day after this surgery. After you go home, you have a big responsibility.

• Pain management: Your child may be in pain. The doctor will prescribe a painkiller like Paracetamol. Give it at the right time and in the right dosage.
• Cleanliness: It is very important to keep the wound clean and dry. Wash your hands thoroughly with soap and water every time you change a diaper. If the wound gets dirty, gently clean it with soap and lukewarm water, then gently pat dry with a clean cloth.
• Changing diapers: The catheter (tube) keeps leaking urine. That's why the diaper is always wet. Change the diaper at least every 2-3 hours. Sometimes doctors will tell you how to wear two diapers, make a hole in the inside of the diaper and put the catheter out, and let the urine collect in the outside diaper.
• Bathing: It is not a good idea to bathe your child in water until the catheter is removed. Wet a sponge with water and wipe the body (sponge bath).
• Activity restrictions: Avoid running, jumping, riding a bike, or vigorous exercise for 2-3 weeks after surgery. If you have a small baby, avoid putting them in toys that have their legs spread apart (e.g., walkers, riders).

What are the risks and complications?

As with any surgery, there are some risks, but these are very rare.

• General risks: Risks related to anesthesia, wound infection, blood clot formation (hematoma), swelling, bruising, etc.
• Specific risks:
• Fistula (Urethrocutaneous fistula): This is a relatively common complication. Simply put, a small hole forms somewhere in the newly created urethra and urine starts to leak through it. If this happens, another minor surgery will be needed to repair it.
• Urethral stricture: A scar may form at the surgical site and block the urethra, causing a decrease in urine flow.
• Wound not healing properly: Sometimes the grafted tissue may not adhere properly.

If something like this happens, don't panic. Your doctor will treat it as needed. The success rate of this surgery is more than 90%. So it's important to think positively.