Hypospadias

Definition
Hypospadias is a relatively common abnormality in which the opening of the urethra is on the underside, rather than at the end, of the penis.

Causes, incidence, and risk factors

Hypospadias is a congenital defect that affects up to 3 in 1,000 newborn boys. The condition varies in severity. In most cases, the opening of the urethra is located near the tip of the penis on the glans. More severe forms of hypospadias occur when the opening is at the midshaft or the base of the penis. Occasionally, the opening is located in the scrotum or the perineum (behind the scrotum).

This anomaly is often associated with chordee, a downward curvature of the penis during erection. (Erections are common with infant boys.)

Some cases are inherited - others result from unknown causes.

Symptoms

     
  • The opening of the urethra is not at the tip of the penis but is displaced to the underside.  
  • The penis has a marked curvature downward.  
  • The penis looks hooded due to malformation of the foreskin.  
  • The child must sit down to urinate.

Signs and tests

Diagnosis is made on physical examination. For hypospadias occurring at the base of the penis, radiologic studies may be necessary to look for other congenital anomalies.

Treatment

Infants with hypospadias should not be circumcised. The foreskin should be preserved for use in later surgical repair.

Surgery is usually completed before the child starts school. Today, most urologists recommend repair before 18 months of age. During the surgery, the penis is straightened and the hypospadias is corrected using tissue grafts from the foreskin. The repair may need to be performed in stages, requiring multiple surgeries.

Expectations (prognosis)

Results after surgery are typically good, both cosmetically and functionally. Approximately 10-20% of the operations require revision for fistulas (which result in leaks) and chordee recurrence.

Complications

If hypospadias is untreated, a boy may have difficulty with toilet training and problems with sexual intercourse in adulthood. Urethral strictures and fistulas may form throughout the boy’s life, requiring surgical correction.

Calling your health care provider

Typically a child is diagnosed with hypospadias shortly after birth. If you notice that your son’s urethral opening is abnormally located, or if his penis becomes curved during erection, call your health care provider.

Do not have the child circumcised if hypospadias is suspected.

Johns Hopkins patient information

Last revised: December 5, 2012
by David A. Scott, M.D.

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