Navigating urethral defects in newborns

The arrival of a newborn is typically a moment of pure joy and celebration for parents.

However, for some families, this happiness may be cut short by unexpected news of a condition known as Hypospadias and Chordee.

According to Dr Tim Jumbi, a pediatric urologist and surgeon, hypospadias is a congenital condition where the opening of the urethra, through which urine passes, is not located at the tip of the penis as it should be.

“Instead of being at the tip, the opening can be anywhere along the underside of the penis, sometimes as far back as the scrotum,” he says.

According to the World Health Organization (WHO), hypospadias affects approximately one in 250 male births worldwide.

On the other hand, chordee is when the baby’s penis bends or twists, especially while it is erect. While it may not have much negative impact in childhood as hypospadias, it may prevent normal sexual functions later in life, if it is not corrected.

In Kenya, hypospadias cases are slightly higher, estimated at 1 in 300 male births. Across Africa, rates vary but generally fall between 1 in 250 to 1 in 500 male births.

Dr Jumbi explains the importance of early diagnosis.

“Typically, hypospadias is diagnosed at birth when nurses or doctors notice an abnormality in newborn boys,” he says. However, he notes a significant disparity in diagnosis rates between urban and rural areas in Kenya.

“In urban areas, awareness and access to specialised care lead to higher diagnosis rates. But in rural regions, many cases go undetected or untreated,” says Dr Jumbi. 

A 2018 study published in the East African Medical Journal reported that approximately 60 per cent of hypospadias cases in Kenya were diagnosed in urban centers, while only 40 per cent were identified in rural areas.

Even more concerning, Dr Jumbi estimates that up to 50 per cent of cases in rural Kenya may go undiagnosed or unchecked. 

This aligns with a 2021 global review in the Journal of Pediatric Surgery, which estimated that between 30-50 per cent of hypospadias and chordee cases in developing countries, including parts of Africa, may go undiagnosed or untreated due to lack of awareness, limited access to healthcare, and socio-cultural factors.

The causes of hypospadias and chordee remain a subject of ongoing research.

“We know there’s a genetic component,” Dr Jumbi explains, adding, “but environmental factors also play a role.”

A 2019 study in the Journal of Pediatric Urology highlighted an increasing global prevalence of hypospadias and chordee over recent decades, suggesting that environmental factors, including endocrine-disrupting chemicals, might be contributing to this trend. Left untreated, hypospadias can lead to several complications. “Boys may not be able to urinate standing up, and later in life, sexual function can be affected,” the Urologist explains. 

“There’s also a significant psychological impact, particularly on self-esteem.”

The primary treatment for hypospadias is surgical correction, ideally performed between six  and 18 months of age.

“We aim to correct the defect before the child starts school,” explains Dr Jumbi. “This minimises the psychological impact and allows for better healing.”

The surgical procedure, called Urethroplasty involves reconstructing the urethra to extend to the tip of the penis. Recovery typically involves 3-7 days in the hospital, followed by about two weeks of home recovery.

However, surgery is not without risks. “The most common complication is a fistula, which can occur in up to a third of cases,” Dr Jumbi cautions. 

“This results in two urinary openings and may require additional surgery to correct.”

Success rates vary depending on the severity of the condition.

“In mild cases, we see success rates of up to 90 per cent,” Dr Jumbi notes. “But severe cases can have more challenging outcomes, sometimes requiring multiple surgeries.”

Dr Jumbi performs an average of 80 hypospadias surgeries annually, reflecting the condition’s prevalence. However, he stresses that this number represents only a fraction of the cases in Kenya, given the challenges in rural areas.

A 2020 study in the African Journal of Urology highlighted the challenges of managing hypospadias in resource-limited settings across Africa. 

The research emphasised the need for more trained pediatric urologists and better access to specialized care in rural areas.

Despite these challenges, Dr Jumbi sees progress. “The availability of services in Kenya has largely improved,” he says. 

“We’ve trained more surgeons capable of performing these complex surgeries, and the necessary equipment and infrastructure are now more accessible locally.”

Looking to the future, he mentions ongoing research into non-surgical treatments.