Hypospadias is generally classified according to the location of the urethral opening. The classification helps guide assessment and surgical planning.
In distal hypospadias, the opening is located near the head of the penis. This form is generally less complex than more proximal forms, although the individual anatomy still determines the treatment plan.
In midshaft hypospadias, the opening is located along the underside of the penile shaft. The surgeon assesses the urethral tissues, penile curvature and other features before recommending treatment.
In proximal hypospadias, the opening is located closer to the base of the penis or the junction with the scrotum. These cases may involve more complex reconstruction and can require a staged surgical approach.
Not every child with hypospadias requires the same operation. The surgeon should explain the type of hypospadias, the goals of treatment and the expected complexity of the procedure.
The decision to operate depends on the location of the urethral opening, urinary function, penile curvature and other anatomical findings. Some children may have a mild form that requires careful assessment before deciding whether surgery would offer meaningful benefits.
When surgery is indicated, primary repair is commonly planned during infancy, often between 6 and 18 months of age. The exact timing depends on the child’s health, the severity of the condition and the treating surgeon’s assessment.
The goals of treatment may include:
The benefits, limitations and potential complications should be discussed with the parents or guardians before a treatment decision is made.
The surgical approach depends on the location of the urethral opening, the urethral plate, penile curvature, tissue availability and whether the child has undergone previous surgery.
The surgeon examines the penis and assesses the position of the urethral opening, any curvature and the surrounding tissues. The child’s medical history and general health are reviewed.
Parents can discuss the proposed technique, whether one or more operations may be needed, the expected recovery and the potential risks.
Hypospadias repair in children is generally performed under general anesthesia. The paediatric anesthesia team assesses the child and provides instructions about preparation, fasting, medications and postoperative monitoring.
Parents should disclose all relevant medical conditions, allergies and medications to the treating team.
During surgery, the surgeon reconstructs the urethra using a technique selected for the child’s anatomy. The procedure may also involve correcting significant penile curvature and providing appropriate tissue coverage.
Some cases can be treated in one operation, while more complex cases may require staged reconstruction. The surgical plan should be explained to the parents before surgery.
A small urinary catheter or stent may be placed to help drain urine while the reconstructed area heals. A dressing may also be applied to protect the surgical site.
The need for a catheter, its duration and the timing of dressing removal depend on the technique and the treating surgeon’s protocol. Parents receive instructions for caring for the child at home and arranging follow-up.
Recovery varies according to the complexity of the repair, the surgical technique and the child’s individual healing. Swelling, bruising and tenderness can occur during the early postoperative period.
The child is monitored after surgery, and pain relief is provided according to the medical team’s instructions. Feeding and normal fluid intake can usually resume as advised by the treating team.
Parents should follow the specific instructions for wound care, medication, clothing and activity. Do not apply unprescribed products to the surgical site.
If a catheter or stent has been placed, it must be cared for according to the instructions provided by the surgical team. Parents should know how urine is expected to drain and whom to contact if the tube becomes blocked, comes out or appears not to be working.
Do not remove or reposition the catheter or dressing unless instructed by the treating team.
The timing for returning to normal activities depends on healing and the surgeon’s advice. Activities that may put pressure on or injure the surgical area should be avoided until the child is cleared to resume them.
Follow-up appointments are important for checking the wound, urinary function and the progress of healing.
