Hypospadias is one of the most common congenital conditions affecting the male urinary system, occurring in about 1 in 200 male births. It involves an abnormal placement of the urethral opening, which is located on the underside of the penis instead of at the tip. While it can cause functional and cosmetic concerns, modern surgical techniques provide excellent outcomes when treated early.
What Is Hypospadias?
In boys with hypospadias, the urethral opening can be found anywhere along the underside of the penis, including:
• Near the tip (mild form).
• Midway down the shaft.
• At the base of the penis or even in the scrotum (severe form).
This condition is often accompanied by other features, such as:
• Chordee: A downward curvature of the penis.
• Incomplete Foreskin Development: The foreskin is usually underdeveloped on the underside, giving the penis a hooded appearance.
Causes of Hypospadias
The exact cause is unknown, but it is believed to result from a combination of genetic, hormonal, and environmental factors:
• Hormonal Influence: Insufficient testosterone or its effect during fetal development can disrupt urethral formation.
• Family History: A genetic predisposition is common, with higher chances if a father or sibling had hypospadias.
• Environmental Factors: Certain maternal exposures during pregnancy, such as endocrine-disrupting chemicals, may increase the risk.
Types of Hypospadias
1. Anterior (Distal)
• The urethral opening is located near the tip of the penis.
• Most common and least severe type.
2. Middle (Midshaft)
• The opening is located along the shaft of the penis.
3. Posterior (Proximal)
• The opening is near the base of the penis or in the scrotum.
• Often associated with chordee and more severe functional issues.
Symptoms and Diagnosis
Hypospadias is usually diagnosed during a physical examination shortly after birth. Symptoms or features include:
• Abnormal location of the urethral opening.
• Downward curvature of the penis.
• Difficulty urinating in a straight stream.
• Hooded foreskin with incomplete closure on the underside.
Why Early Treatment Is Important
If left untreated, hypospadias can lead to:
• Difficulty Urinating: Challenges with aiming or controlling the urine stream.
• Sexual Dysfunction: Problems with erections and reproduction later in life.
• Psychological Concerns: Issues related to appearance can affect self-esteem during adolescence or adulthood.
Treatment Options for Hypospadias
1. When to Treat
• Surgery is usually performed between 6 months and 18 months of age. At this age, children heal faster and experience fewer complications.
2. Surgical Repair
• Goals of Surgery:
• Relocate the urethral opening to the tip of the penis.
• Correct chordee for a straightened penis.
• Reconstruct the foreskin, if necessary.
• Procedure:
• A pediatric surgeon uses tissues from the foreskin or inside the mouth to create a new urethra (urethroplasty).
• This is usually an outpatient procedure or requires a short hospital stay.
3. Post-Surgical Care
• A small catheter may be placed temporarily to ensure proper healing.
• Parents are instructed to monitor for infection, swelling, or discomfort.
Prognosis
With timely and appropriate surgical treatment, most boys with hypospadias achieve:
• Normal urinary function.
• A straightened, cosmetically normal penis.
• No long-term complications in adulthood, including sexual or reproductive issues.
When to Avoid Circumcision
If your child has hypospadias, do not circumcise before consulting a pediatric surgeon. The foreskin tissue is often needed for surgical repair.
Final Thoughts
Hypospadias is a manageable condition when diagnosed and treated early. With advances in pediatric urology, most children recover fully and lead healthy, normal lives. If your child has been diagnosed with hypospadias, consult an experienced pediatric surgeon for guidance and care.
Need more information? Contact us to schedule a consultation with our expert pediatric surgical team.