What is the right age for Hypospadias Surgery?

This is another query commonly asked by the parents. I have dealt with this question in the ‘FAQ’ section of my ‘Hypospadias Surgery’ book.

In most standard textbooks, the best time for hypospadias operation is mentioned as 6-18 months of age. This is based on 3 assumptions:

1. It is easier to manage the child after the operation
2. Operation on the genitalis at this age has less psychological effects on the child
3. Results of hypospadias surgery are better in younger children than older children and adults

While there is some truth in the above assumptions, it is not backed by available scientific data. Let us examine the factors that are important for the success of hypospadias operation. In the author’s view, the 2 most important factors are the severity of hypospadias defect and the surgeon’s expertise. The severity of the defect is acquired by birth and cannot be altered; the parents have to search for the expert surgeon for their child.

However, the other very important factor that influences the surgical result is not the age of the child, but the size of the penis. In many cases of hypospadias, the penis is small in size, especially in a young child (6-18 months of age) and any operation on a small penis has a very high risk of failure. So, instead of operating on a small child with a small penis, it is better to wait till the penis size is adequate. In many children, the penis grows for a few years after birth and may reach a reasonable size by 2 years of age. If, by 1.5-2 years of age, the penis is still small, it is better to increase the size of the penis with a small dose of hormone injection before planning for the surgery. Such a method helps to increase the size of the penis and helps in availability of better quality tissues for reconstruction. However, the surgery should be done 4-6 weeks after the hormone injections for best results.

In a child with hypospadias and a good (adequate) penis size, surgery can be done at any age, as early as 6 months. However, when the penis is small, we prefer to wait till 1.5-2 years of age for natural growth; if the penis still remains small, we stimulate the growth by hormone injections and then perform the operation before 3 years of age. This is to ensure that by the time the child goes to school, he should have a straight penis with normal urination from the tip, so that he will not have any psychological issues.

Thus, Hypospadias surgery should be completed in childhood (by 3 years of age if possible) and in the worst scenario, at least before 12 years of age, before he becomes an adult. Hypospadias surgery in adolescents and adults is not only very difficult for the surgeon, but the results are not as good as in childhood.