Hypospadias is a birth defect (congenital condition) in which the opening of the urethra is on the underside of the penis instead of at the tip. The urethra is the tube through which urine drains from your bladder and exits your body.
Hypospadias is common and doesn't cause difficulty in caring for your infant. Surgery usually restores the normal appearance of your child's penis. With successful treatment of hypospadias, most males can have normal urination and reproduction.
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Before Hypospadias Treatment
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
When to see a doctor
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.
How does hypospadias affect the penis?
Early in a baby’s development, the urethra starts as an open channel. The tube closes as a baby develops before birth. The urethra's opening — where sperm and urine exit — is called the meatus (me-ATE-us). Typically, the meatus is at the tip of the penis.
In a baby with hypospadias, the meatus forms in a different location. It might be on the shaft of the penis or the scrotum instead of on the penis’s tip.
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.
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.
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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
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.
Can I prevent hypospadias?
Pregnant people can reduce the risk of their baby having hypospadias by practicing a healthy lifestyle:
. Don’t smoke or drink alcohol.
. Maintain a healthy weight.
. Take folic acid (around 400 to 800 micrograms a day) while pregnant.
. See your healthcare provider for regular checkups while pregnant.
Are there complications from hypospadias surgery?
Sometimes, a hole called a fistula can form from the urinary tract to the penis skin. And some babies have some scarring that can affect urine flow. If you notice your child leaking urine or having a weak, slow urine stream after surgery, contact your healthcare provider.
During Hypospadias Treatment
What are the types of hypospadias?
Healthcare providers describe the type by where the urethra opens:
. Subcoronal: Near the head of the penis.
. Midshaft: Along the penis shaft.
. Penoscrotal: Where the penis and scrotum meet.
How is hypospadias treated?
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 can correct hypospadias. With newer surgical methods, children can have corrective surgery at an earlier age. Your healthcare provider will discuss the exact timing of your child’s surgery.
Many pediatric urologists do the surgery when your child is between six and 12 months old. At that age, it’s easier to care for the surgery site after the operation. It’s also safer for your child to have anesthesia.
What is the goal of hypospadias surgery?
The goal of hypospadias repair is a straight penis with a urethra in the right spot, at the penis tip. Babies with hypospadias should not be circumcised. The surgeon may use extra skin from the uncircumcised foreskin to do the repair.
During the surgery, the urologist:
. Straightens the penis shaft.
. Builds a new urethra.
. Positions the urethral opening at the tip of the penis.
. Reconstructs the foreskin.
What should I expect during my baby's surgery?
Your baby will be under general anesthesia during the surgery. They will be asleep and not feel any pain. Occasionally, the baby needs two surgeries: one to straighten the penis and one to fix the urethra. But often, the surgeon does it in one procedure. You can usually take your child home on the day of the surgery.
After Hypospadias Treatment
What happens after hypospadias surgery?
The baby may need a small tube called a catheter to pee. Usually, the catheter stays in for a few days or up to two weeks. Your healthcare provider will prescribe antibiotics to reduce the risk of infection. Pain medication can relieve discomfort.
How do I care for my baby after surgery?
You will get instructions about how to care for your baby during recovery, including how to:
. Bathe your baby.
. Tend to the bandage.
. Recognize signs of infections or complications.
Follow the instructions closely, and keep an eye on your baby’s recovery and the surgery site. The full healing process takes a few months. You may notice bruising and swelling, but that will go away in the first few weeks.
How can I best take care of my baby?
If your child had hypospadias surgery, don’t let them play on toys that require straddling, such as riding toys or walkers, until your healthcare provider gives the all-clear. You may also want to use double diapers to provide extra cushion.
When should I see my healthcare provider?
Your baby will likely recover fine without any complications. The urine might appear pink for a few days after surgery. But call your provider right away if you notice:
. Fever of 102° F or higher for more than 24 hours.
. Difficulty peeing or inability to pee.
. Blue or gray discoloration at the tip of the penis.
. Discomfort despite pain medication.
. Bleeding from surgical site.
What is the outlook for children with hypospadias?
Hypospadias (and chordee) repair procedures are very successful. Most repairs last a lifetime. The penis has a normal, healthy function. Your child’s healthcare provider will discuss the schedule of any needed follow-up appointments.
Can adults have hypospadias surgery?
Yes. Surgery can correct hypospadias in children of any age and in adults.
Is hypospadias the same as a curved penis (chordee)?
They are not the same condition. But babies with hypospadias can sometimes have a curved penis, called chordee or congenital penile curvature.
How common is hypospadias?
Hypospadias is common. It affects approximately one of every 250 to 300 newborn males. The rate seems to be rising in Western cultures — possibly because of the increased use of pollutants and pesticides.