Hypospadias

Overview

Hypospadias is a birth difference in which the opening of the urethra (the tube that carries urine out of the body) is located on the underside of the penis instead of at the tip. It develops before birth, while the penis is forming. It is one of the more common birth conditions affecting the genitals in boys.

The opening can be just below the tip or further down toward the base, and some boys also have a downward curve of the penis (called chordee) or an unusual foreskin. Hypospadias does not cause pain, and most cases are mild. It is typically treated successfully with surgery, after which most boys have normal urination and, later, normal sexual function.

Symptoms

Hypospadias is usually noticed at birth or during a newborn examination. Signs depend on how far down the opening is and may include:

• The urethral opening located on the underside of the penis rather than at the tip
• A downward curve of the penis (chordee), especially during erection
• An abnormal spray or downward direction of the urine stream
• A foreskin that is incomplete and forms a hood over the top of the penis

Hypospadias is not painful and does not itself cause urinary infections. Milder forms may cause few practical problems, while more pronounced forms can affect urination and, later, sexual function if not treated.

Causes

Hypospadias occurs when the tissues that form the urethra and foreskin do not develop completely during pregnancy. In most cases the exact cause is not known. Factors that may play a role include:

• Genetics: It can run in families, suggesting inherited factors contribute.
• Hormonal influences: Hormones guiding genital development before birth may be involved.
• Other factors during pregnancy: Various prenatal factors have been studied, but for most individual cases no single cause is identified.

Hypospadias is not caused by anything a parent did or did not do during pregnancy.

Risk Factors

• A family history of hypospadias
• Certain genetic or hormonal factors affecting genital development
• Some pregnancy-related factors that have been associated with higher risk
• Premature birth or low birth weight in some cases

Diagnosis

Hypospadias is usually diagnosed by physical examination, often shortly after birth:

• Newborn examination: A doctor identifies the position of the urethral opening, any penile curve, and the appearance of the foreskin.
• Assessment of severity: Determining how far down the opening is helps plan treatment.
• Specialist evaluation: A pediatric urologist may assess more pronounced cases and, occasionally, check for related conditions.

Because the foreskin is often used in repair, families are usually advised not to have a routine circumcision before a specialist has reviewed the condition.

Treatment

Treatment is usually surgical and is performed by a pediatric urologist:

• Surgical repair: An operation moves the urethral opening to the tip of the penis, straightens any curve, and reconstructs the appearance, often using foreskin tissue.
• Timing: Surgery is commonly done in infancy, often between several months and around the first year or so of age, depending on the child and the surgeon's recommendation.
• Number of operations: Mild cases may need a single procedure, while more pronounced cases may require more than one.

After successful repair, most boys urinate normally and grow up with normal sexual function. Some milder cases that cause no problems may, after discussion, not require surgery.

Prevention

• Hypospadias generally cannot be prevented, as it forms during development before birth
• Routine prenatal care supports overall pregnancy health
• If there is a family history, discussing it with a doctor can help families know what to expect
• Avoiding routine circumcision before specialist review preserves tissue that may be needed for repair

When to See a Doctor

Hypospadias is usually identified by the medical team at birth. Speak with your child's doctor if you notice:

• The urethral opening is not at the tip of the penis
• The penis curves downward
• The urine stream sprays or points downward
• The foreskin looks incomplete or hood-like

After surgical repair, contact the surgical team if you notice problems such as difficulty urinating, swelling, bleeding, signs of infection, or leakage of urine from a new opening.

Related Topics

Frequently Asked Questions

References

1. Mayo Clinic. Hypospadias — Symptoms and causes.
2. MedlinePlus, U.S. National Library of Medicine. Hypospadias.
3. American Urological Association (AUA).
4. Centers for Disease Control and Prevention (CDC). Birth Defects.