Hypospadias Repair
Hypospadias repair moves the urinary opening to the tip of the penis, straightens any downward bend and reshapes the glans and foreskin, ideally between six and eighteen months of age. Distal forms are repaired in one operation, while proximal forms often need two stages for fewer complications. At Biruni Hospital in Istanbul, our pediatric urologists plan each repair, manage catheter care and follow boys through puberty.
About This Department
In hypospadias, the opening of the urethra sits on the underside of the penis. Repair moves it to the tip, straightens the penis and restores a normal appearance.
Hypospadias repair is surgery for boys born with the urinary opening below its normal position at the tip of the penis, often with a downward bend and an incomplete foreskin. The operation builds a new urethral channel to the tip, corrects the bend and reshapes the glans and skin, usually between six and eighteen months of age. Distal hypospadias, near the tip, is repaired in one operation. In a review of 3,368 distal repairs, a fistula, a small leak along the new channel, followed 3.8 percent of tubularized incised plate repairs (Wilkinson and colleagues, Journal of Pediatric Urology, 2012). Proximal hypospadias, near the scrotum, is more complex. In 2,664 boys, complications occurred in 21 percent after two-stage repair and 42 percent after single-stage repair, and results improved in high-volume centers (Babu and Chandrasekharam, Journal of Pediatric Urology, 2021). This page explains types, timing, techniques, hormones before surgery, curvature, risks, catheter care, long-term follow-up, and how families from abroad arrange hypospadias repair at Biruni Hospital in Istanbul.
What hypospadias is
The foreskin is often used in the repair. Boys with hypospadias should not be circumcised before seeing a pediatric urologist.
Do not circumcise first
Keep the foreskin.
In hypospadias the foreskin provides extra skin that the surgeon may need to build the new urethra, cover it with a protective layer or close the skin underneath, and once it has been removed at a religious or newborn circumcision, the repair becomes harder and may need grafts from elsewhere. Families who plan circumcision for religious or cultural reasons can have it done during the hypospadias repair, when the surgeon decides how much foreskin to keep or remove.
Check with us first. Circumcise later.
Types of hypospadias
| Type | Position of the opening | Share of cases |
|---|---|---|
| Distal, anterior | Near the tip, on the glans or just below | Most boys, about two thirds |
| Midshaft | Along the shaft | About one in six |
| Proximal, posterior | Base of the penis, scrotum or perineum | About one in six, most complex |
Did something during pregnancy cause it?
Assessment and timing
| Check | Why | When |
|---|---|---|
| Examination of both testes | Undescended testes with hypospadias need further tests | First visit |
| Chromosome and hormone tests | Proximal hypospadias with undescended testes may signal a difference of sex development | When indicated |
| Penile size and glans width | Plan the technique and hormone treatment | First visit |
| Kidney ultrasound | Only if other anomalies present | Selected boys |
Repair between six and eighteen months of age is standard. The child does not remember the operation, and the tissues heal well.
Repair of distal hypospadias
| Outcome | Tubularized incised plate | Mathieu flap |
|---|---|---|
| Urethral fistula | 3.8 percent | 5.3 percent |
| Narrowing of the new opening | 3.1 percent | 0.7 percent |
| Appearance of the opening | Vertical slit, natural | Rounder |
A one-stage repair takes one to two hours and is the standard for most boys with distal hypospadias.
- Bring the opening to the tip of the glans.
- Straighten the penis.
- Reshape the glans and skin for a normal appearance.
Some families choose no surgery for very mild distal forms where the stream and appearance are acceptable.
Repair of proximal hypospadias
| Approach | Complication rate | Note |
|---|---|---|
| Single stage, foreskin tube | 42 percent | Remained high despite experience |
| Two stage, free foreskin graft | 23 percent | Fewer fistulas and narrowing |
| Two stage, foreskin flap | 20 percent | Improved with higher case load |
Why two operations instead of one?
Experience matters
Hypospadias surgery rewards practice.
The meta-analysis found that complications after two-stage repair fell as the number of operations a center performed each year rose, supporting the idea of dedicated hypospadias teams, while single-stage repair of severe forms stayed difficult even in busy centers. Our pediatric urologists perform these operations every week, use magnifying loupes and fine absorbable stitches, and follow each boy through puberty.
Families can fairly put the same question to any team, how many repairs it performs each year and how it follows boys afterward, and a confident team will answer with real numbers and a clear plan for the years until puberty.
Hormones before surgery
| Study type | Effect on complications | Quality |
|---|---|---|
| Three randomized trials | Fewer complications, relative risk 0.36 | Moderate |
| Observational studies | No clear difference | Low, risk of bias |
| Side effects | Mild and temporary | Darker skin, hair, irritability |
When we use it
Straightening the penis
A bend that remains after repair causes problems in adult life. Straightening is checked during surgery with an artificial erection test.
How it is done
- Releasing the skin often corrects mild bends.
- Tightening the upper side corrects moderate bends.
- Lengthening the underside corrects severe bends, sometimes in the first of two stages.
Techniques
| Degree of bend | Technique | Note |
|---|---|---|
| Under 30 degrees | Skin release, dorsal plication | Most distal cases |
| 30 to 45 degrees | Plication or plate mobilization | Midshaft cases |
| Over 45 degrees | Ventral lengthening, staged repair | Proximal cases |
Risks and fistula
A fistula shows as urine coming out of a second small hole along the shaft. It does not close by itself and is repaired six months after the original operation.
How will we know if something is wrong after surgery?
The day of surgery
| Step | Timing | Note |
|---|---|---|
| Arrival and checks | Morning | Numbing cream |
| Anesthesia | Parent present at induction | General with caudal block |
| Surgery | One to three hours | Longer for proximal repair |
| Recovery | Two hours | Catheter and dressing |
| Discharge | Same day or after one to two nights | Depends on repair |
Pain relief
Dressing and catheter at home
| Item | What to do | Duration |
|---|---|---|
| Dressing | Keep dry, double diaper | Until removal at day 3 to 7 |
| Catheter or stent | Drains into the diaper | Five to ten days |
| Bathing | Short baths after dressing removal | From day 5 to 7 |
| Medicines | Pain relief, antibiotic, bladder spasm medicine | As prescribed |
| Sign | Possible cause | Action |
|---|---|---|
| No urine for several hours | Blocked catheter | Call at once |
| Fever | Infection | Call the same day |
| Bleeding soaking the dressing | Wound bleeding | Gentle pressure, call |
| Catheter falls out | Displacement | Call for advice |
Mild swelling and bruising of the penis are normal and settle over two to three weeks.
Long-term follow-up
Talking with your son
Children ask questions when they notice differences.
Simple, honest answers at each age, that he had a small operation as a baby to make it work well, help a boy feel confident, and older boys can join the follow-up discussions.
Shame has no place here.
For families from abroad
Families planning circumcision at the same time tell us in advance, so that it is built into the plan.
Cost
What a quote covers
| Item | Included | Priced separately |
|---|---|---|
| Surgery | Pediatric urologist, anesthesia, operating room | Second stage |
| Hospital | Day case or one to two nights | Extra nights |
| Aftercare | Dressing and catheter removal, medicines, video follow-up | Hormone treatment, fistula repair |
The price depends on the type of hypospadias, one or two stages and hormone treatment.
References
- Wilkinson DJ, Farrelly P, Kenny SE. Outcomes in distal hypospadias. A systematic review of the Mathieu and tubularized incised plate repairs. J Pediatr Urol. 2012;8(3):307-312.
- Babu R, Chandrasekharam VVS. Meta-analysis comparing the outcomes of single stage (foreskin pedicled tube) versus two stage (foreskin free graft and foreskin pedicled flap) repair for proximal hypospadias in the last decade. J Pediatr Urol. 2021;17(5):681-689.
- Chua ME, Gnech M, Ming JM, et al. Preoperative hormonal stimulation effect on hypospadias repair complications. Meta-analysis of observational versus randomized controlled studies. J Pediatr Urol. 2017;13(5):470-480.
Editor's note
Written by the Biruni Hospital medical editorial team. Reviewed by Assoc. Prof. Dr. Elif ACAR ARSLAN, Pediatric Neurology.
Medically reviewed by
Assoc. Prof. Dr. Elif ACAR ARSLAN
Pediatric Neurology
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