Hypospadias repair w/o using foreskin...

[mommyswenn]

Does anyone have any experience with this? My ds (11 months) has severe hypospadias (peno-scrotal) as well as significant chordee. He will be having the first of two surgeries to repair these defects in April or May (just waiting to hear from our Children's Hospital as to the date). In all my research/reading about this I've never heard it being repaired without using the foreskin (they use it to reconstruct the urethra).

However, I can't help feeling that we are being robbed of our choice not to circ. One could argue that we need not do the repair, but if we leave things the way they are our son will never be able to pee standing up, nor would he have a normal sex life. My dh and I are confident we are making the right decision for our son and we are comfortable with the urologist who will be performing the surgeries. But I just can't help feeling bitter about the irony, and unfairness of it all -- we had decided we wouldn't circ if we ever had a son (we had three girls before our boy), yet here we are, left without a choice...

I posted this on another anti-circ board, and someone suggested posting here to see if anyone had any information about hypospadias repair that doesn't use the foreskin. So here I am.

Thanks for listening.

[DahliaRW]

I did some googling for you and found that there are techniques that can be used that preserve the foreskin. I would talk about this with the urologist/surgeon performing the operation, and if they have no idea what they are talking about go find another doc. JMHO. Maybe Frank will have some more info for you.

http://www.cirp.org/library/restoration/gray1/

[MommytoB]

http://www.cornellurology.com/uro/co...ospadias.shtml

For the most severe defects, we can remove mucosal skin from the inside of the cheek or use subdermal skin from other hairless parts of the body. It is important to use hairless skin as future hair growth in the neourethra can present multiple problems

[Frankly Speaking]

Mommyswenn, please describe your son's penis. Where is his urinary opening and how much foreskin does he have?

The procedure Dahlia linked has been used in Europe for more than 15 years and has been very successful. Unfortunately, on this continent, it is just being discovered and not many urologists know about it. Your son deserves the best and least invasive procedure possible.

If the hypospadias is on the glans, surgery may not be necessary. However, if it is below the glans, it will be necessary. If there is sufficient foreskin, the procedure linked above can be used and the foreskin can be repaired at the same time to function as normal. That's the object of the surgery . . . to come out of in as normal as possible.



Frank

[pdx.mothernurture]

mommyswenn,

So glad you made it over here.

Hope you get the answers your looking for, keep us updated.

Jen

[mommyswenn]

Hi Frank,

My son's hypospadias is peno-scrotal, which means his urethral opening is at the base of his penis where it meets his scrotum. If the opening were on the glans, simply "off-centred," we would have opted to not have the surgery. Unfortunately his case is in the 15% considered the most severe and we really feel like we have no option.

As well, because they have to rebuild a longer urethra, the possibility already exists that they may need to use skin grafts (as I understand it, from inside his cheeks). I am not sure if they would consider using only grafted skin to rebuild the urethra, leaving the foreskin intact. I will check out the link that was provided.

Jonah also has the "hooded" foreskin often associated with hypospadias, so he looks more circ'ed than intact (so I'm told by my friends who have circ'ed sons, I really have no frame of reference since he is our first boy).

I think as parents we all second-guess our decisions (especially monumental ones, like this is for us). As his surgery date gets closer and more real, the harder this is becoming for me to deal with. He is just such a happy, perfect little boy as he is that it breaks my heart to know what we are putting him through. But given the severity of his hypospadias and the significant chordee he has, we really feel that we don't have a choice.

ETA -- I checked out the link Dahlia provided. My son's hypospadias is not distal, so that technique wouldn't be possible.

[mightymoo]

If the foreskin HAS to be used to do the surgery than that is what needs to be done, but I would not CIRC him to do it, I would have them use as much as they need and leave the rest and even try to repair it to be as normal as possible - he may not have a full foreskin, but when he's older he can always use the restoration techniques to expand the skin he has left to create a full foreskin

[Frankly Speaking]

Mommyswenn, from your description, I agree with your doctor and you that the repair is necessary for your son to have a functional penis. I know this is heart breaking for you and I wish I could do something that would make things easier.

Possibly, there is a better way than the option you have been given. Let's consider the procedure you read about and see if it's possible. I want to explore this with you because if it is possible, it would be far less invasive and traumatic for your son and that's what we really want.

I want you to take a look on the underside of your son's penis. I imagine that the area is "butterflied" or spread open. I want you to take special notice of the skin in that area. There is a type of skin called "mucosal skin" that is designed to be in an area that is constantly wet. You find this type of skin on the inside of the eyelids, in the mouth, in a female's vaginal cleft, on the inside of the foreskin, on the glans, etc. Is the skin in the splayed out area this type of skin and different that the skin on the uppper or dorsal side of the penis? If it is, then the procedure discussed in the link is probably possible and there may be enough to make the repair using the technique in the link without harvesting from the foreskin and very likely that none will have to be harvested from another part of the body. This means one surgical site rather than two and a little boy in much less pain and trauma.

As for the foreskin, since it is hooded, it is not likely that it will function as a foreskin normally functions. There is no frenulum and no frenar band. With the severety of your son's case, I doubt there is enough tissue to fashion a normal appearing and mostly normal functioning foreskin. You and your surgeon make that decision but you have the trump card in that decision.

If you are not sure about the procedure or if you want to research more or get a second or third opinion, take the time you need. The procedure should be done by the time your son is 3 years old, so you have another 2 years to make a final decision. Until then, your son will be in diapers, so it won't matter that he can't stand and aim. Also, with it being done that early, your son is not likely to have any memory of it.

MightyMoo, in these cases of severe hypospadias, there is usually very little foreskin there. It is truly a "flap of skin" that covers maybe a quarter to a third of the glans lengthwise and maybe a half to three quarters of the way around. It's much like a clitoral hood in that it is not a full sleeve of skin but a hood of skin. It has little, if any function sexually. It can also be a problem in that it is exposed to detrius and the area can become irritated quite easily in some boys. From a restoration standpoint, I doubt it would offer any advantage as it would be longer on the dorsal side than on the ventral side. This is also not really a circumcision because a circumcision cuts all of the way around the penis and this would only cut about half way around. The longer dorsal side and the shorter ventrical side could pose some unique problems in restoration and a uniform skin sleeve would not have those particular challenges.




Frank