Summer 2012

Hypospadias Treatment Demands Broader Awareness

Because hypospadias occurs on the penis, the condition does not get prime ad space on city buses or in the New York Times, even though hypospadias — the incomplete development of the urethra — is among the most common congenital anomalies and there is a safe and effective surgical treatment for it.

Dr. Laurence Baskin

Dr. Laurence Baskin

Laurence Baskin, M.D., chief of Pediatric Urology at UCSF Benioff Children's Hospital, says, "Awareness is crucial because of the parental stress, physical challenges, self-esteem and relationship issues that arise from not treating the hypospadias or by a poorly done surgery.
But in the hands of a skilled and experienced surgeon, surgical repair, the only known treatment, can restore normal appearance and ensure proper functionality, including sexual function."

Experience Matters

At UCSF, studies have shown that the overwhelming majority of hypospadias surgeries are successful, with few complications. Complications that do occur, typically fistulas, are almost always minor and readily corrected with a follow-up procedure.

Baskin, who has completed over 1,500 hypospadias surgeries, feels that the ideal time for surgical reconstruction is 6 months of age. At this time, anesthesia is safe, pain is better controlled, healing is rapid and it's generally easier for parents to care for their infant.

Hypospadias illustration  Hypospadias illustration

This schematic illustrates a technique, developed at UCSF, to straighten
the penis, often a critical step in hypospadias repair.

"The best shot is the first shot," Baskin says "Revision surgery is a much more complicated procedure, and we're seeing more of these, often because the procedure was not done correctly the first time by a less experienced surgeon."

In addition, because the foreskin is used to repair the urethra, infants with hypospadias should not be circumcised prior to the definitive surgical repair.

Is Prevention Possible?

With the prevalence of hypospadias on the rise in some regions of the world, Baskin and his colleagues at UCSF lead a number of studies to understand causes and develop prevention strategies. Genetic susceptibility and environmental factors are believed to be the two primary causes.

"While we have not conclusively established effective prevention methods, we do counsel patients that there are potential causative agents that they can avoid," Baskin says.

The research continues.

For more information, contact Dr. Laurence Baskin at (415) 353-2200.

 

Summer 2012 Table of Contents

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