Hypospadias is a condition where the meatus isn’t at the tip of the penis. Instead, the hole may be any place along the underside of the penis. The meatus (hole) is most often found near the end of the penis (“distal” position). But it may also be found from the middle of the penile shaft to the base of the penis, or even within the scrotum (“proximal” positions). Over 80% of boys with this health issue have distal hypospadias. In 15% of those cases, the penis also curves downward slightly, a condition called “chordee.” When the meatus opens further down the shaft, curvature occurs in more than 50% of patients. Hypospadias is a common birth defect found in up to 1 in every 200 boys.
In most cases, hypospadias is the only developmental problem in these infants and doesn’t imply there are other flaws in the urinary system or other organs.
Symptoms
In hypospadias, the opening of the urethra is located on the underside of the penis instead of at the tip. In most cases, the opening of the urethra is within the head of the penis. Less often, the opening is at the middle or the base of the penis. Rarely, the opening is in or beneath the scrotum.
Signs and symptoms of hypospadias may include:
- Opening of the urethra at a location other than the tip of the penis
- Downward curve of the penis (chordee)
- Hooded appearance of the penis because only the top half of the penis is covered by foreskin
- Abnormal spraying during urination
Most infants with hypospadias are diagnosed soon after birth while still in the hospital. However, slight displacement of the urethral opening may be subtle and more difficult to identify. Talk to your doctor if you have concerns about the appearance of your child’s penis or if there are problems with urination.
Causes
Hypospadias is present at birth (congenital). As the penis develops in a male fetus, certain hormones stimulate the formation of the urethra and foreskin. Hypospadias results when a malfunction occurs in the action of these hormones, causing the urethra to develop abnormally.
In most cases, the exact cause of hypospadias is unknown. Sometimes, hypospadias is genetic, but environment also may play a role.
Risk factors
Although the cause of hypospadias is usually unknown, these factors may be associated with the condition:
- Family history. This condition is more common in infants with a family history of hypospadias.
- Genetics. Certain gene variations may play a role in disruption of the hormones that stimulate formation of the male genitals.
- Maternal age over 35. Some research suggests that there may be an increased risk of hypospadias in infant males born to women older than 35 years.
- Exposure to certain substances during pregnancy. There is some speculation about an association between hypospadias and a mother’s exposure to certain hormones or certain compounds such as pesticides or industrial chemicals, but further studies are needed to confirm this.
Complications
If hypospadias is not treated, it can result in:
- Abnormal appearance of the penis
- Problems learning to use a toilet
- Abnormal curvature of the penis with erection
- Problems with impaired ejaculation
Diagnosis
Your child’s pediatrician can diagnose hypospadias based on a physical exam. He or she will likely refer you to a surgeon who specializes in genital and urinary conditions (pediatric urologist) for further evaluation. Medical centers with specialty teams can help you evaluate options and can provide expert treatment.
When the opening of the urethra is abnormal and the testicles cannot be felt on exam, the genitals may be difficult to identify as clearly male or female (ambiguous genitalia). In this case, further evaluation with a multidisciplinary team is recommended.
Treatment
Some forms of hypospadias are very minor and do not require surgery. However, treatment usually involves surgery to reposition the urethral opening and, if necessary, straighten the shaft of the penis. Surgery is usually done between the ages of 6 and 12 months.
If the penis looks abnormal, circumcision should not be done. If hypospadias is found during circumcision, the procedure should be completed. In either case, referral to a pediatric urologist is recommended.
Surgery
Most forms of hypospadias can be corrected in a single surgery that’s done on an outpatient basis. Some forms of hypospadias will require more than one surgery to correct the defect.
When the urethral opening is near the base of the penis, the surgeon may need to use tissue grafts from the foreskin or from the inside of the mouth to reconstruct the urinary channel in the proper position, correcting the hypospadias.
Results of surgery
In most cases, surgery is highly successful. Most of the time the penis looks normal after surgery, and boys have normal urination and reproduction.
Occasionally, a hole (fistula) develops along the underside of the penis where the new urinary channel was created and results in urine leakage. Rarely, there is a problem with wound healing or scarring. These complications may require an additional surgery for repair.