Is Hypospadias Surgery a Minor Operation?

Doctor, we thought Hypospadias surgery is a minor operation. Only after my son’s operation failed 2 times, I realised that it is a major and difficult operation.

Last week I had a call from a child’s mother from a town that is 800 Kms away from Hyderabad. This lady had got my reference from the internet, where she had seen my website and heard my talks about hypospadias on YouTube. She called me to discuss her son’s hypospadias problem. She told me that her 3-year old son had already undergone 2 operations for hypospadias, but both the operations had failed, and the child is passing urine mainly from the original hole itself. She was very upset, unhappy and very concerned about her son’s future. I reassured her that we can fix the problem again and everything would be alright.

The situation described above is not uncommon. Most parents, when they realise that their child has hypospadias, think that it is a minor problem and can be corrected with minor surgery. So they do not search for an expert surgeon for their child’s hypospadias surgery. Only after the operation has failed 1 or more times (I have seen a child in whom hypospadias surgery had failed 8 times!!), the parents realize that it is a very difficult and technically demanding operation and they should search for an expert hypospadias surgeon. Unfortunately, by the time this happens, the child would have undergone multiple failed operations. Each failed operation not only increases the financial burden on the family, but it is also a horrible experience to the child and the family. To add to this, each failed operation makes a re-operation much more difficult, even for an expert hypospadias surgeon. Such a situation is avoidable, if only the parents search for an expert hypospadias surgeon in the beginning itself.

Why is Hypospadias Surgery not a Simple or Minor Operation?

1. Hypospadias surgery (even distal or mild hypospadias) involves a lot of reconstructive surgery. In general, any reconstructive surgery is considered technically demanding.
2. Hypospadias surgery should take care of both cosmetic and functional results.
3. After hypospadias operation, the child should not have any problem with passing urine at least 4-5 times a day throughout his life. So the effects of the operation are life-long.
4. The operation should also take into consideration the sexual and family life of the child when he grows older.
5. The penis is a small structure with limited healthy tissues available. The surgeon should be well versed with optimal utilization of the available tissues to ensure a good result in the first attempt itself.
6. Once hypospadias operation fails, further re-operations are more difficult, because the limited tissues of the penis are used up in the first operation. So it is important to avoid failure of operation as much as possible.

In summary, hypospadias is a difficult reconstructive operation with long-lasting effects on the child and the family. So hypospadias surgery should not be taken lightly.

What is the best way to ensure good results with hypospadias surgery? Is it by taking the child to a big hospital? Unfortunately most parents think that if they take their child to a big hospital, all their problems will be sorted out! However, there is no guarantee that the hospital will have an expert surgeon, especially with expertise in hypospadias surgery. Many times the parents realise this very late and after many painful experiences. Thus, my suggestion to parents is to search for an expert hypospadias surgeon from the very beginning itself, so that the majority of failures and complications can be avoided. The child should be taken to the expert surgeon, whichever hospital that surgeon is consulting. Even if the parents have to travel to another city to get their child treated by an expert, it is worth it, rather than going to the expert after they develop complications of hypospadias operation.

In summary, parents should not take hypospadias as minor or easy operation. They must search for the expert hypospadias surgeon from the beginning itself, so that their child can get the best chance of good results with the initial operation itself.