1. What is the best age for treatment?
In general, proper penile development is more favorable for reconstructing the urethra. In foreign countries, surgery is started when the child is about half a year old. Due to the limitations of the yellow race’s own development, as well as the conditions of care and post-operative family health support, Professor Chen Shaoji generally recommends starting surgery around one and a half years old. This will solve the problem before the child understands it and can avoid causing excessive psychological impact on the affected child. However, the timing of surgery is not an absolute thing, and is mainly based on the local condition of penile development. For children with good penile development it is possible to start surgery around the age of one year, and for patients with heavy hypospadias who need staged surgery it is also recommended to start the first surgery around the age of one year, so as to leave more adequate time for the second stage of surgery. Therefore, it is recommended that after the diagnosis of hypospadias is clear after birth, it is not necessary to wait until the age initially stated by the doctor, but to see a specialist around the age of one year to measure the timing of surgery in relation to the child’s condition and the doctor’s situation.
2.Is it bad for the baby’s development if the treatment is late?
Penis development mainly depends on the patient’s own developmental ability, and there are differences in the size of the penis in normal people. In the past 30 years of surgical treatment and follow-up, we found that most children with hypospadias have similar penile development as normal children when they enter puberty after surgery, and a few children with combined penile dysplasia can benefit from earlier human intervention for later development. The main concern is the psychological impact on the child. The psychological impact of a child entering kindergarten or school and not being able to stand up to urinate is still relatively large, and most children will have low self-esteem and even be autistic. They may be reluctant to communicate with other children and may even resist going to school. Children usually start to have such awareness around the age of three, so we recommend that the treatment should not be later than three years old.
3.What are the criteria for a good surgical treatment of hypospadias?
In the past, the goal of surgery was more on the level of assurance of urinary function. After the results of our follow-up survey of adult cases, it seems that the most important thing for children with hypospadias to focus on in adulthood is whether the appearance of the penis is close to normal. That is why in recent years we have proposed at several meetings new criteria for the treatment of hypospadias as follows.
Normal or near-normal appearance – approximates post-circumcision appearance
Standing urination
erect and straightened
Orthostatic urethral opening
Appropriate urinary stream and line
Normal sexual function in adulthood
Low complication rate
4.What is the success rate of hypospadias surgery?
We generally use the complication rate to count the level of the surgeon’s surgery. We have accumulated a wealth of experience in surgical treatment since the 80’s. The requirements for the surgeon’s professional skills are very strict, and we have gradually established a follow-up system for patients and set up a special post-operative consultation support at a later stage. Therefore, our complication rate is quite low: the complication rate of primary cases within 5 years is less than 10%; the complication rate of primary cases in the last two years is less than 5%; the complication rate of reoperation in our group is about 15-20% for multiple surgical cases in outside hospitals. It is a leading level in China and even in the world. The complication rate in some domestic hospitals where the treatment of hypospadias is more concentrated is generally around 15-30%.
5.Does the surgery affect my sex life in the future?
According to the long-term follow-up, most of the children recovered relatively well in adulthood, and the physiological level of sexual function is close to normal, but the psychological factor of sexual function and satisfaction of sexual life is significantly reduced in patients with older age of surgery.
6.Does it affect fertility after surgery?
For male fertility depends mainly on the quality of sperm, hypospadias surgery is to create conditions for normal sperm discharge, for future fertility can check the quality of semen when the child enters late adolescence. Furthermore, about 10% of normal people are infertile, which should be understood correctly.
7.Do all cases of hypospadias need surgery?
For patients with mild hypospadias whose curvature is not obvious and whose urethral opening is on the head of the penis and does not affect urination and sex life much, parents can choose whether to operate or not. Because this kind of patients most of the time will not affect the normal life, only the appearance is different from normal people, the main impact is the patient’s psychological condition.
8.Does anesthesia have any effect on the child’s intelligence?
Anesthesia is generally safe and reliable with sacral anesthesia, and there will be no other problems. The argument that it affects intelligence is that decades ago, when the development of anesthesia was relatively rudimentary, some drugs such as ether were used for anesthesia, which easily produced secretions that blocked the airway and caused accidental inhalation of oxygen deprivation and other conditions, resulting in the impact on intelligence. Now there are no such problems.
9.What are the complications after surgery?
Suburethral cleft surgery is a relatively delicate urological surgery. The main complications that may occur after surgery are urinary fistula, urethral stricture, diverticulum, urethral splitting, residual curvature, etc. For hypospadias treatment centers in specialized fields like ours, the chances of serious postoperative complications are smaller because the surgeon’s operation is more professional and standardized, the requirements for details are stricter, the treatment experience is richer, and the corresponding instructional examinations accompanying the postoperative operation are more complete. The usual postoperative complication is a urinary fistula, which is not difficult to repair again. Among the postoperative complications of hypospadias, the management of urethral strictures is more important. If treated early, the results may be better and some of them do not require further surgical treatment, and if the urinary line becomes thin and is not treated in time for follow-up, the persistent strictures can bring about urinary tract dysfunction and be difficult to deal with.
10. Is care or surgery more important in this type of surgery?
The recovery of the postoperative wound and the recovery of the urethra are mainly determined by the child’s own ability to repair, as the recovery varies with individual physique. The multiple stages of complications can occur within a year. This requires parents to pay close attention to the child’s urination and to go to the hospital to see a doctor to dilate the urethra in time if they find that the urine line has become thin.