Q&A: Mom Needs Advice on Whether Son Needs Surgery

Q: My son was born with a moderate hypospadias condition. Initially, we were told that he could have a problem being able to stand to urinate. He is now 21 months old, can stand to urinate, so functionally he is fine. We are still contemplating whether or not to go ahead with a surgical procedure that would be only cosmetic in nature. According to medical research, this is one of the most common congenital anomalies in baby boys. Why has no one ever heard of it? Would you enlighten the public as to what it is and how frequently it occurs?
Thanks,
North Shore mom

A: Thank you for writing in about this issue not only due to how important a topic it is for boys but because it raises some interesting questions about making medical decisions for young children that have not only cosmetic implications but functional and emotional consequences later on.

Hypospadius is a congenital abnormality of the placement of the urethral opening. It occurs in 1 out of 250 boys and there are often other male relatives who have it. Normally the urethral opening is at the very tip of the penis. In hypospadius, that opening ends up either along the side of the penis and can be anywhere from near the top to down low by the scrotum. This has a number of implications. First, depending on the location of the opening the urine often can not come out in a way that would allow a boy to stand while urinating. Second, many boys with hypospadius develop a curve to their penis with erection called a chordee. If this is present, these boys will have sexual difficulty as men and trouble with fertility due to poor position of the sperm after ejacuation.

The repair is surgical and usually done before a child is 2 years of age. The extent of surgery is determined by the severity of the hypospadius and a pediatric urologist would be the person to consult. But, the goals are the same for all boys with hypospadius – to allow the boy to stand when urinating and to repair any chordee so that there will be no curve to the penis with erection. Some kids need a simple operation and others more involved.

Grownups often have trouble talking about issues involving the sexual organs of their kids and that may be one reason you have not come across anyone whose son has a hypospadius. Even as adults, we become invested in knowing our kids are “normal” and whether they will be able to be productive adults and parent children. So, some people become embarrassed by this type of condition and not comfortable talking opening about it with their peers to avoid having their child viewed a “freak”.

The cosmetic consideration is a tough one. It’s hard to predict how your son will feel later in life not looking like his dad and his friends. While your son can stand to urinate now when he is barely 2 feet tall, that likely will become very difficult as he gets taller and the urine stream has farther to go to enter the urinal while standing. As his sexual identity develops, he’ll have to confront how women will view him not looking “normal” and the fact that fathering a child may be challenging.

My bias is for a repair in a situation like this because the issues are so crucial to his overall self-esteem and development with far-reaching consequences for his development, gender identity and adult life. A pediatric urologist can help you best in sorting through not only the surgical options but the impact on your son’s future given his specific type of hypospadius.

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