The First Visit to the Urologist
by Betty Engel, HEA Webmaster
Note: This information is mainly intended for parents of children with hypospadias. Please email us if you can help write questions that parents of children with epispadias, exstrophy, or related conditions should ask.
First of all, take a bunch of deep breaths and relax. Generally, hypospadias is not the sort of condition that requires quick decisions and fast actions. Generally, having hypospadias is not a medical emergency. Your first visit to the pediatric urologist is almost always for an evaluation—you're going to find out information and check out the quality of the doctor. You're not signing up for surgery at this point.
You might want to ask the urologist at least some of the following questions:
1. What is the degree of severity of your child's condition? For hypospadias, this is determined by the position of your child's meatus (pee hole). If it's near the tip of the penis, it's mild. If it's near the middle of the shaft, it's moderate. If it's at the base of the penis or near the anus, it's severe. Mild hypospadias doesn't require any surgical intervention when considering function. Your boy will probably pee normally, have sex normally, and father children normally. Moderate hypospadias may require surgery at some point for full functionality, especially if some other condition exists, like chordee (bending of the shaft of the penis). Severe hypospadias often requires surgery at some point.
2. Are any other conditions, such as chordee, present?
3. Do you think my child's hypospadias may require surgery? Why?
4. If my child needs surgery, when do you think it should be done? Why then?
Now you want to ask some questions to determine the qualifications of this urologist for giving an evaluation of your child, and for doing surgery if you decide this is necessary. It is really really important to make sure your doctor has lots and lots and lots of experience with hypospadias patients and with several techniques for performing surgery.
5. How many hypospadias patients do you see in a month?
6. How often do you recommend that surgery not be done because it is not needed?
7. How many hypospadias surgeries have you done this month?
8. How long do you follow up your patients?
9. What do you consider to be a successful surgery?
10. What percentage of your hypospadias surgeries have resulted in a fistula?
11. What percentage of your hypospadias surgeries have resulted in an infection?
12. What percentage of your hypospadias surgeries have needed another surgery?
13. What percentage of your hypospadias surgeries require re-repair when the patient has become an adult?
14. What procedures have you used for the surgical treatment of hypospadias, and how many of each type of procedure have you done?
15. Does the hospital where this doctor practices use a team approach? Who are the members of the team (social worker, psychologist, genetic specialist, endocrinologist, etc.)?
That should be enough questions for the first visit. If the doctor is uncomfortable or defensive about answering these questions, he or she is almost surely not someone you want caring for your son.
These are the kinds of questions that have been suggested to us by members of the top hypospadias medical teams in the US and Canada. You'll read on the message board about the men whose surgeries were botched by inexperienced surgeons. And you'll read about the complications like scarring, loss of sensitivity, strictures, fistulas, etc. that all-too-often come from surgery. I believe that some scarring and some loss of sensitivity is universal. More extensive surgeries result in more scarring and greater loss of sensitivity.
So you see that you'll be making some tough decisions, but that you generally have lots of time to make them. You need to decide if surgery is necessary at all, and if it can be delayed until your child is old enough to take part in making this important decision. Of course, you are the only person who knows about your situation and about the needs of your child and your family, so think these matters through for yourself.
Related Information: Accord Alliance's Talking with Your Child's Medical Care Providers.
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