# Academic question - hypospadias



## vachi73 (Mar 26, 2009)

I have a friend whose 7m just had hypospadia repair, during which the baby was circ'd to provide skin to graft onto the defects.

I understand from my friend (did not do my own research) that this is the common approach to hypospadia repair ... but does anyone know of other alternatives to circ'ing for this defect? Just so that I have the info.

(FWIW, I have two intact boys, 5y and 3.5y, and am expecting twins in December, of unknown genders - any boys will also be intact! - ... so it's truly theoretical at this point







)

Thanks!


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## MCatLvrMom2A&X (Nov 18, 2004)

It is the most common way here in the USA to do it because Dr. see no value in keeping the foreskin. But in Europe they do the repair while saving the foreskin if at all possible. It depends on the severity of the hypo and if chordee is involved and how bad it is.

My personal opinion is leave it alone if the boy can urinate properly and do the surgery later when things are bigger and even in some case leaving it for the boy to decide if/when he wants the surgery.

Here are the links I have on hypo. Be aware some have graphic pictures of the repair itself.

Hypospadias no pictures: http://www.cirp.org/library/restoration/gray1/

Hypospadias drawing: http://images.google.com/imgres?imgu...l%3Den%26lr%3D

Hypospadias pictures with chordee at the bottom & Warning graphic surgery pictures: http://www.emedicine.com/PED/topic1136.htm

Hypospadias from mild to severe: http://www.medscape.com/content/2004...89956.fig4.jpg

Hypospadias drawing of were all the urinary openings can be: http://www.hypospadias-emotions.com/images2/hyposp6.jpg


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## perspective (Nov 3, 2007)

Quote:


Originally Posted by *vachi73* 
I have a friend whose 7m just had hypospadia repair, during which the baby was circ'd to provide skin to graft onto the defects.

I understand from my friend (did not do my own research) that this is the common approach to hypospadia repair ... but does anyone know of other alternatives to circ'ing for this defect? Just so that I have the info.

(FWIW, I have two intact boys, 5y and 3.5y, and am expecting twins in December, of unknown genders - any boys will also be intact! - ... so it's truly theoretical at this point







)

Thanks!

Yes, its just using the foreskin as a skin graft is common in the US for this procedure, because its seen simply as "extra skin". While in the UK, and other countries this at times may also be done, an alternative procedure is becoming the norm where they instead use skin from the inside of the mouth in the "repair" process.

I say repair in quotes because as this condition becomes more common (1 100 to 1 in 300, depending where you get your numbers) people are starting to question the purpose of the surgery in the first place. Often in situations where the urethra opens on a lower part of the head it is believed that no surgery needs to be done at all.

As a young guy born with this condition, and who had the "repair" surgery, if I could have had the choice, I dont think I would have gotten it done in the first place. Often the purpose of repairing these milder cases is solely to make the boy look "normal" in the eyes of the parents/doctors. But really, normal is what your born with, and yes it may be different, but if there are no health issues associated, then no surgery should be done because in the eyes if the child, what he has is normal.

There was a study done that talked to men with hypo who had the repair, and those who did not, and overall the men who did not have the repair as babies were more content with their bodies then men who had the surgery when they were babies. (I dont have a link to it, but it was posted on these boards) Meaning, unless there is a REAL medical need, this surgery should be avoided. Also in cases where it is needed, there is no reason to circumcise to have the operation turn successfully.


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## Nandi (Jul 12, 2008)

Of course there are all the usual risks associated with general anesthesia and surgery in general i.e. infection, so it seems that waiting until the person could decide for himself would be the most prudent choice, if the child is able to urinate. I observed this surgery in a pediatric OR and the words that come to mind are fillet of penis. We had another poster say that the doc suggested surgery so the boy would be able to pee standing up, and that was the only reason. Not a good one, in my opinion...


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## vachi73 (Mar 26, 2009)

Thanks so much for this info! I don't have a specific use for it, and hope not to of course, but given the incidence/prevalence of hypospadias, I'm sure it will come around again sometime.

FYI I also found an article online that referenced a different type of repair, that saves the foreskin, I think called GRAP? IT may be similar to that used in the UK (using tissue from the mouth) ... anyway, just so glad to know there might be another choice the next time I hear about this.


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## GISDiva (Jul 13, 2007)

Quote:


Originally Posted by *perspective* 
I say repair in quotes because as this condition becomes more common (1 100 to 1 in 300, depending where you get your numbers) people are starting to question the purpose of the surgery in the first place. Often in situations where the urethra opens on a lower part of the head it is believed that no surgery needs to be done at all.

And that's exactly what we decided to do. DS's case was very mild, he was able to pee just fine. Luckily we found a very nice urologist who thought the same. He said as long as it looked like he wasn't going to "tinkle on his shoes", he didn't see any reason at all to do repair. However, I'm sure if it was a bit lower and the whole "peeing standing up" thing became an issue, he perhaps would have been more insistent, I don't know.

I am curious as to why these are becoming more common, our doctor said that she's seeing more and more of them.


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## perspective (Nov 3, 2007)

Quote:


Originally Posted by *GISDiva* 
I am curious as to why these are becoming more common, our doctor said that she's seeing more and more of them.

Back in the 1950's, it would be unusual to see it. You can clearly see how rapidly its becoming more common because of the numbers, not too long ago it was 1 in 300, then it was 1 in 150, then 1 in 125, and more recently I have been even seeing articles that use 1 in 100! That means in a medium to large size school there will these days be many boys who were born with this condition!

One cause of hypo is genetic, something like if a boy has had this condition there is a 20% that another male in his family does as well. This is where most of the original cases came from.

Although there is a better explanation for the steady increase in hypospadias in the last few decades. (This dramatic increase is ONLY happening in 1st world countries mind you)

That is Phthalates. Phthalates, aka plastic softeners which are used on many of the plastics we use everyday. This chemical is VERY commonly used, but only really becomes a problem when are the most exposed to it. Probably the most common example (and the most dangerous) is used on water bottles. Because here very low levels of this is released into the water contained in those bottles. Another contact pint comes in the form of the spray from hair spray. Women (and possibly men) who are exposed to Phthalates on a regular basis are more likely to see this condition in their children. As a society we use this stuff more, the higher rates of this we will see.

This is something the FDA has NOT looked into enough yet, and is a serious problem for boys who get serious cases of hypo. Not only that, but other chemicals are starting to be seen as causing other health problems in the male body, yet at least at this point, little is being done.

Links:

http://www.sph.emory.edu/PEHSU/html/.../endocrine.htm

http://www.ourstolenfuture.org/NEWSC...27swanetal.htm

http://www.worldwatch.org/node/5484

In depth article on the subject:
http://www.huffingtonpost.com/mark-s...t_b_93092.html


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## MyBoysBlue (Apr 27, 2007)

There is also a Canadian documentary called the "Dissapearing Male" that goes into the role of plastics and male genital deformities among other things. There may be a youtube link if you google it. But the CBC website link can't be viewed outside of Canada.


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## mommyminer (Aug 20, 2006)

My nephew almost died from this surgery - and I'm not being dramatic. No matter the info I gave my sis-n-law, she insisted on circing her twin boys. One twin was born with hypo. They took their son to a highly recommended ped uroligist 1.5 hrs away. Apparantly his penis continued to bleed. By the time my sis-n-law got her son back to the hospital (ab 24 hrs after the surgery), his hemoglobin was 4 and he needed two blood tranfusions.


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## Night_Nurse (Nov 23, 2007)

Quote:


Originally Posted by *mommyminer* 
By the time my sis-n-law got her son back to the hospital (ab 24 hrs after the surgery), his hemoglobin was 4 and he needed two blood tranfusions.

I'm curious to know if that possible risk was mentioned in the consent form she signed?


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## PuppyFluffer (Mar 18, 2002)

Quote:


Originally Posted by *mommyminer* 
My nephew almost died from this surgery - and I'm not being dramatic. No matter the info I gave my sis-n-law, she insisted on circing her twin boys. One twin was born with hypo. They took their son to a highly recommended ped uroligist 1.5 hrs away. Apparantly his penis continued to bleed. By the time my sis-n-law got her son back to the hospital (ab 24 hrs after the surgery), his hemoglobin was 4 and he needed two blood tranfusions.

I'm also curious also as to whether the consent form contained this possible risk.

Also, what is the mom's current feeling on circ. Would she do it again after this experience?


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