Hypospadias is a birth defect where the urethral opening (where the urine comes out) is on the underside of the penis instead of at the tip:
Boys born with hypospadias can also have:
- A “partial circumcision” or “dorsal hood”
- Ventral curvature (penis curves down)
There are mild cases and severe cases based on how much curvature the penis has and how far away the opening is from the tip.
Also, there is a distinct type of hypospadias called MIP (megameatus intact prepuce) hypospadias, where the foreskin is normal and there is no curvature. Hypospadias is usually noted during or after the boy undergoes a circumcision:
Surgical correction of hypospadias
Most mild cases can be corrected by a single surgery with a high success rate. The most commonly used technique is the tubulirized incised plate (TIP) repair –also called the Snodgrass repair.
The TIP repair provides a normal circumcised appearance with around 5% chance of complications:
Transposition of genital skin during TIP repair
Some boys with hypospadias have deficient foreskin on the front of the penis. Foreskin from the back of the penis is “transposed” to the front to compensate for the deficiency:
More severe cases of hypospadias commonly require 2 operations to achieve the best outcomes.
There are several types of 2-stage repairs, but a technique popularized by Dr. Bracka called the Staged Autograft Repair (STAG), has been gaining popularity in the last decade due to low complication rates and good cosmetic outcomes.
The STAG repair also provides a normal circumcised appearance with around 15% chance of complications. The STAG repair is done in 2 stages:
- Stage 1: curvature is corrected and the skin graft (foreskin) is laid over the penis
- Stage 2: 6 months later, the graft is used to form a new urethra.
Here is a video of the first stage repair:
And a video of the second stage: