Hypospadias Surgery

The treatment for hypospadias is surgical repair. Hypospadias is generally repaired for functional and cosmetic reasons. The more proximally ectopic the position of the urethral meatus, the more likely the urinary stream is to be deflected downward, which may necessitate urination in a seated position. Any element of chordee can exacerbate this abnormality. Fertility may be affected. The abnormal deflection of ejaculate may preclude effective insemination, and significant chordee can preclude vaginal insertion of the penis or can be associated with inherently painful erections.
Minor cases of hypospadias, in which the meatus is located up toward the tip of the glans, may not require surgical repair and may simply be managed with observation. It must be kept in mind, however, that although the most minor forms of hypospadias are insignificant in physiologic terms, they too may merit repair on the basis of the potential psychological stress associated with having a genital anomaly.

Surgical Care

The goals of surgical treatment of hypospadias are as follows:

• To create a straight penis by repairing any curvature (orthoplasty)
• To create a urethra with its meatus at the tip of the penis (urethroplasty)
• To re-form the glans into a more natural conical configuration (glansplasty)
• To achieve cosmetically acceptable penile skin coverage
• To create a normal-appearing scrotum

The resulting penis should be suitable for future sexual intercourse, should enable the patient to void while standing, and should present an acceptable cosmetic appearance.