Care of a child with hypospadias: ethical issues in practice

Care study John, a 6-year old, was undergoing his sixth hospital admission (Table 1). He had been born with hypospadias, a congenital malformation of the genitalia resulting in the urethral orifice being found on the ventral surface of the penile shaft. In John's case it was at the base of the penis. With this condition, chordee (ventral curvature of the penis) often occurs due to the presence of fibrous tissue (Fig. 1). Surgery may be performed in stages to release the chordee and progressively extend the length of the urethra (Waley and Wong, 1991). The purpose of the surgery is threefold: to enable the child to void urine in the standing position; to improve the cosmetic appearance of the genitalia; and to produce an adequate organ for sexual activity.