Hypospadias repair surgery: what is it?
Hypospadias is a congenital condition that entails the dislocation of the meatus (opening) of the penis from its normal position, i.e., the tip of the glans (head).
Hypospadias is a common birth abnormality of the male reproductive system, affecting about one in every 250 males at birth.
While the exact cause of hypospadias is unknown, it is said to result from the urinary channel’s failure to tubularize completely to the end of the penis. Moreover, approximately 10% of hypospadias cases are a part of a syndrome with multiple abnormalities.
Hypospadias repair surgery lasts between one to three hours. It typically involves moving the urethral opening to its normal location, straightening the curved shaft of the penis, and circumcising any abnormally formed foreskin.
Hypospadias can be treated with hypospadias repair surgery, which involves straightening the penis and moving the meatus to the penis tip.
The overall success rate of hypospadias repair surgery is not more than 60%. The ten commandments of hypospadias surgery were introduced to improve the success rate of hypospadias repair surgery.
The following is a discussion on the matter in further detail.
1. Interlocking Sutures
An important commandment of hypospadias surgery is taking continuous interlocking sutures. Additionally, the suture line must be interrupted by taking a knot after every five stitches.
This suture policy ensures that the sutures are watertight, and if there is an accidental break in the middle of the suture line, the whole suture line does not unwind.
2. Dartos Flap
Dartos is a vascular tissue that helps in wound healing. In hypospadias repair surgery, a Dartos flap must be raised from the scrotum to ensure excellent recovery. This flap is strong and has an excellent blood supply. Both these qualities ensure protection and provide support to the suture line, thereby preventing the formation of a fistula.
3. Suprapubic Diversion
The healing period for hypospadias repair is approximately 3 to 4 weeks. A urethral stent is inserted to aid recovery. However, removing the stent a week after the surgery is too early.
It is because urine flows with pressure, which can disturb mucosal healing. For this reason, suprapubic diversion is advised for approximately three weeks.
Collagen is laid down by the end of the third week following the surgery. Collagen helps give strength to the suture line, thereby aiding healing. Suprapubic diversion reduces the risk of fistula formation by 50%.
4. Rotating Preputial Skin
It is crucial not just to rotate the Byar’s skin flaps after the surgery but also to preputial skin. Cutting the preputial hood may jeopardize the blood supply of the skin flaps. Compromised blood supply, furthermore, may lead to necrosis and, ultimately, operation failure.
Additionally, the suture line of the urethra crosses the skin, which violates the basic principles of surgery.
Experts advise the use of tourniquets instead of adrenaline infiltration to reduce bleeding. Adrenaline may provide a false sense of reduced bleeding and may result in the formation of big hematomas that may impair the recovery process.
Additionally, if adrenaline enters the bloodstream, it may lead to serious cardiac arrhythmias and necrosis of the skin around the infiltration site.
6. Surgical Site Dressing
For the dressing, the penis is covered with a Sofra-Tulle with a gauze piece over it. Elastoplasts are used for compression dressing as it helps reduce post-operative bleeding, prevents the formation of any hematomas, and protects the surgical site from any possible injuries.
Many cases of hypospadias surgery report poor or delayed healing despite good surgical outcomes. Experts advise the consumption of a high protein diet to ensure adequate wound healing, including eggs, meat, or protein powder. A high protein diet helps ensure proper and timely recovery.
8. Bipolar Cautery
Experts recommend using only bipolar cautery for hypospadias repair surgery. Bipolar cautery is advised to heal any major bleeds. If major bleeders are not cauterized, there is a possibility of a major hematoma formation following surgery, which may disrupt the healing process.
Oxybutynin tablets must be administered to the patient twice a day to treat violent bladder contractions. These contractions may contribute to periurethral urine gushes and possibly the formation of a fistula.
The patient must be given Ornidazole to reduce the chances of infection. Post-operative infection is a common occurrence, and Ornidazole helps cut down that risk, thereby ensuring timely and proper healing.
The Ten Commandments use a multidisciplinary approach to healing. The method recorded a 99.4% success rate in hypospadias repair surgery. However, it is critical to understand that post-operative healing patterns are prone to variation.
The tentative recovery period from hypospadias repair surgery is three months on average. However, healing depends heavily on the patient’s circumstances and complications and the employed surgical method.
If you have any concerns about the matter, consult your doctor for the best solution for you.