New Delhi: Neelam was shocked to discover that the baby boy she had delivered did not have a normal urinary opening.
Neelam and her husband were directed to a paediatric surgeon who conducted a through physical check-up of the baby, and told them that he was suffering from hypospadias, a penile defect in male newborns where the opening of the urine tube (urethra) is formed much before the tip of the penis. According to the Hypospadias Foundation, around one lakh boys are born in India with this type of anomaly. The number was calculated from the birth rate for infant boys as per the 2011 Census, and considering that the worldwide accepted incidence of hypospadias is around 1/150 male births. In addition to the hole being in the wrong position, the foreskin is often underdeveloped on the underside, giving it a hooded appearance on top.
Occasionally, the penis may also be bent downward (chordee), typically due to tight skin, though it can also result from an abnormality in the structure of the penis itself. Dr Prabudh Goel, additional professor, pediatrics surgery, at AIIMS-Delhi told PTI that treatment of hypospadias depends on the severity of the condition. Sometimes a child's urinary tract will need to be investigated to make sure that there are no other problems, especially when the abnormality is more severe. "Unless very mild, hypospadias is usually corrected by surgery to move the urethral opening to the tip of the penis and close over the hole that was previously there. This will enable the child to urinate standing up and with a straight stream. It will also correct the bend so that the penis is straight and looks normal," Goel said, adding that the age for the corrective surgery is usually from six to 18 months.
Hypospadias in a male newborn is not an uncommon condition. So parents should not worry and instead consult a pediatric surgeon and get the necessary corrective measures done. Early diagnosis and treatment can restore both the appearance and functioning of the penis in most cases, Goel said. Dr Shandip Kumar Sinha, director of pediatric surgery and pediatric urology at Medanta Hospital, Gurugram, said that maternal exposure to progesterone during pregnancy may increase the risk of hypospadias in a male fetus. Moreover, a baby is more likely to have hypospadias if he has a biological relative -- father or brother -- who also had hypospadias, Sinha said.
According to Sinha, there are three key features of hypospadias, although not all are required for the condition. These features are ventral opening of the urethral meatus, ventral curvature of the penis or 'chordee', and dorsal hooded foreskin, he said. "It is typically easy to diagnose hypospadias because the meatus is not located on the tip of the penis. The foreskin may also be underdeveloped, often leaving the underside of the penis uncovered. Additionally, the penis may have a downward curve or bend. "In more severe cases, the penis can be unusually small or short, and the scrotum may appear divided into two halves," Sinha said. Healthcare providers typically diagnose hypospadias shortly after birth, as part of the routine physical examination performed by a pediatrician. The goals of treatment are to reconstruct a straight penis with a meatus as close as possible to normal site to allow a forward directed urine stream and normal coitus in adulthood, Sinha said.
In most cases, the treatment involves a single surgery. However, some types may require multiple surgeries, he said. The ideal age of repair is controversial, although most surgeons agree that repair should be completed before school admissions, i.e., three years of age. The typically recommended age for a hypospadias repair is between nine months and two years. The success rate of such a surgery is usually high, Sinha said.
