What are the Types of Hypospadias
‘What are the types of hypospadias? What is the basis on which hypospadias is classified as various types? Is there any difference between surgery for mild, moderate and severe cases of hypospadias? How is the result of surgery related to the severity of hypospadias?’
These are the common questions arising in the minds of many parents whose child has hypospadias. We will discuss the types of hypospadias briefly.
Hypospadias is a very versatile and variable defect, so every hypospadias is different. However, for the sake of better understanding and planning treatment, hypospadias is classified as distal (milder forms), moderate and severe cases, based on the position of the urinary opening (meatal position) and the degree of downward bend (chordee) of the penis.
In general, the farther the urinary opening is from the tip of the penis, the more severe the hypospadias. However, hypospadias surgery experts use a better classification of the severity of hypospadias based on the degree of chordee; <150 mild , 15-300 moderate and >300 chordee is severe. This classification based on chordee is important because the technique of chordee correction and hypospadias repair depends on the severity of chordee. In general, the urethral plate can be preserved in mild to moderate degrees of chordee, whereas the urethral plate may need to be divided in cases of severe chordee. The techniques of urethral reconstruction also vary based on the urethral plate quality; in severe cases, the urethral plate typically is poor quality and may require division, excision and 2-stage operation. In most mild to moderate cases of hypospadias, a single-stage repair is possible.
The best hypospadias surgeon is one who has mastered many techniques of hypospadias surgery and can use the right technique for a particular type of hypospadias. There are many techniques for repair of distal types of hypospadias based on urethral plate quality, quality of skin available, size and configuration of glans, mobility and quality of the native urethra and so on. Similarly, moderate types of hypospadias are repaired using a variety of skin flap techniques, and may require additional steps for chordee correction while trying to preserve the urethral plate. In severe cases with chordee >300 (in many cases the chordee is very severe, between 45-900), the urethral plate may need to be divided and excised, along with other additional steps to correct the chordee. These severe cases are typically repaired by a 2-stage operation, consisting of chordee correction and skin grafting in the first stage (where available, the skin is taken from the penile foreskin itself), followed by urethral and penile reconstruction in the second stage. The time gap between both these stages is typically 6-12 months.
All types of hypospadias can be repaired with good results only when they are treated by an expert hypospadias surgeon. The best hypospadias surgeon is one who has special interest and training, but also someone who has extensive experience with hypospadias operations. So it is important for parents to search for the best hypospadias surgeon for their kid. In the hands of expert hypospadias surgeons, complications are minimised and even when a complication occurs, it is usually minor and can be easily tackled. Many times parents make the mistake of thinking that hypospadias is a small and minor operation! Nothing can be further from truth than this. Even lesser degrees of hypospadias (distal hypospadias) require a very skilled and delicate operation to ensure a good cosmetic and functional result. So all that the parents have to do is simple: search for the best hypospadias surgeon for your kid and don’t compromise!