Hypospadias repair and foreskin reconstruction

It’s been awhile since I’ve posted. Life goes by so quickly. But every time I read a comment from a family and tears well up, I know it’s time. We went through this, we still live this and families all over the world are going through it. We’re still shaking off sand from our first ever real family vacation. We went to the island of Maui. And even though it was expensive to haul our family of five across the pacific ocean, through airports and on delayed flights to end up on the beaches lathering hourly sunscreen on our kids’ little bodies, I promised our son as he healed from his stage 2 repair that his little butt would be in the warm tropical sand as soon as we were done. And now, a year and a half out, it was time for that break.

There are lots of questions on foreskin reconstruction. I had found Dr. Snodgrass through forums and other research, however the fact that he practices foreskin reconstruction was another reason why we went to Texas for our son’s repair. Our first son is uncircumcised, and after countless hours of research prior to making that decision, I believe in the role of the foreskin for male bodies.

Although debated and varying in outcome, studies exist on the effect of circumcision on sexual function. A 2013 study, 1, shows in a large cohort of men, that the foreskin has erogenous sensitivity and that after circumcision some genital sensitivity is lost. The study consisted of 1059 uncircumcised and 310 circumcised men. For the glans penis, circumcised men reported decreased sexual pleasure, lower orgasm intensity and stated more effort was required to orgasm. Notably, a higher percentage experienced discomfort and pain, numbness and unusual sensations. In comparison to men circumcised before puberty, men circumcised during adolescence or later indicated less sexual pleasure at the glans penis, and a higher percentage reported discomfort or pain and unusual sensations at the penile shaft.

Although the sensitivity of the foreskin and its importance in erogenous sensitivity is debated, I felt we needed the extra sensitivity the foreskin may provide since the potential already existed for decreased sensitivity from surgery.

Most hypospadias repairs performed in the US involve the removal of the foreskin not used in the repair, resulting in a circumcised penis. One report I found, 2, looked at the experience from four institutions in the reconstruction of the foreskin during penile surgery. Over a 6 year period, 58 patients underwent surgery with reconstruction of the foreskin. Of those, 49 underwent hypospadias repair. Of the hypospadias repairs, 46 were distal, 2 were mid shaft and 1 was proximal. Among the 49 hypospadias repairs, 2 patients had dehiscence of the reconstructed foreskin with development of a urethral fistula in 1. Of the 58 total patients, 56 had retractable foreskin, with 4 requiring post op steroid application. Three families requested a secondary circumcision; 2 for cosmetic result and 1 for personal preference.

In another study, 3, by surgeons at a UK hospital who’s preference is to reconstruct the foreskin unless circumcision is requested, found that foreskin reconstruction in distal hypospadias reduces long term risk of complications. Their study compared the complication rates of distal hypospadias repairs with and without foreskin reconstruction. Information about type of hypospadias, presence of chordee, surgical procedure, surgeon, post op complications including readmission, urethral fistulae, wound infection and dehiscence, meatal stenosis, foreskin complications and details of any further surgery were recorded. In this study, 146 cases were identified (Matthieu 130, Snodgrass 8, MAGPI/meatoplasty 8). 117 (80%) had foreskin reconstruction and 29 (20%) were circumcised. 12 were lost to followup. Followup averaged 3.3 years. Long term complications (3 fistulae, 7 foreskin complications) occurred in 10 of 110 (9%) of the foreskin reconstructions and 6 of 24 (25%) occurred in the circumcised group (2 fistulae, 2 meatal stenoses, 2 dehiscences). In this study, foreskin reconstruction reduced long term complications.

Hypospadias represents a spectrum. Every child requires a surgeon who exercises appropriate judgment and has the experience to correct each variant surgically for the best possible outcome for the child. I’m not a doc or a surgeon, I’m just a mama raising a beautiful little guy born with proximal hypospadias. We’re doing fantastic at this point and I keep a watch of what’s going on and what the future may hold. I wish you all the very best with your little ones and am always here if you need another mom’s support.

Best, Christina

 

1. BJU International. Bronselaer GA1, Schober JM, Meyer-Bahlburg HF, T’Sjoen G, Vlietinck R, Hoebeke PB.
2. Warren T. Snodgrass, Martin A. Koylelow, Laurence S. Baskin, Anthony A. Caldamone appearing in the Journal of Urology, Volume 176, Issue 2, Pages 711–714
3. Liam Mccarthy, Arnold Young, Harish Chandran, Karan Parashar, published by Birmingham Children’s Hospital, Paediatric Urology, Birmingham UK
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