Hypospadias (hi-poe-SPAY-dee-us) is a 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.
You may feel distressed if your son is born with hypospadias. However, hypospadias is common and doesn’t cause difficulty in caring for your infant. In fact, surgery usually restores the normal appearance of your child’s penis. With successful treatment of hypospadias, most males can eventually have normal adult sexual function.
Glanular Hypospadias – The urethral opening develops just below the end of the penis.
Coronal Hypospadias – The urethral opening develops in the groove where the head of the penis (glans) meets the shaft.
Penile Shaft Hypospadias – The urethral opening develops anywhere along the underside of the shaft of the penis.
Perineal Hypospadias – The urethra opens in the scrotum.
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In hypospadias, the opening of the urethra is located on the underside of the penis instead of at the tip. The severity of the condition varies. In most cases, the opening of the urethra is near the head of the penis. Less often, the opening is at midshaft or at 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
Hypospadias is present at birth (congenital). The exact reason this defect occurs is unknown. Sometimes hypospadias is inherited.
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.
Though the cause of hypospadias is unknown, both environmental and genetic factors have been associated with the condition, including:
Family history. This condition is more common in infants with a family history of hypospadias.
Maternal age over 40. Some research suggests that there may be an increased risk of hypospadias in infant males born to women of an advanced age.
Exposure to smoking and chemicals. There is some speculation about an association between a mother’s exposure to pesticides and hypospadias, but further studies are needed to confirm this.
If your infant son is diagnosed with hypospadias while still in the hospital after birth, you’ll likely be referred to a pediatric urologist.
If your child’s hypospadias is less severe, however, it may be overlooked in the hospital. If you think your son has hypospadias, call your family doctor or pediatrician.
If your child will be seeing a pediatric urologist, you may want to check your health plan to see if it covers meeting with this specialist.
It’s a good idea to arrive well prepared to your appointment. Here’s some information to help you get ready, as well as what to expect from your doctor.
What you can do
Ask a family member or friend to come with you. It can be upsetting to find out that there’s something wrong with your child, possibly making it difficult to remember all of the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
Write down questions to ask your doctor.
For hypospadias, some basic questions to ask your doctor include:
Does my child need to have surgery?
When is the best time for surgery?
What are the risks associated with this surgery?
Could my child outgrow this condition?
What happens if he doesn’t have the surgery?
Will this condition affect my son’s fertility or sexual function later in life?
If I have another child, what are the odds that this might happen again?
Are there brochures or other printed material that I can take with me? What websites do you recommend?
What to expect from your doctor
It’s also a good idea to be prepared for any questions your son’s doctor may ask. For hypospadias, he or she might ask:
Does your son’s penis curve downward during erection?
Have you noticed any abnormal spraying when your son urinates? (This may be difficult to distinguish in an infant.)
Boys with Hypospadias are more likely to have Undescended Testes.The most common implications of Hypospadias are difficulty urinating. It is difficult for the child to urinate standing as the stream of urine splatters all over the place. The cosmetic appearance of penis in Hypospadias is different from other boys which can be a cause of anxiety. The penis in Hypospadias may be curved which might make it difficult to have sexual intercourse and / or cause painful erections (Priapism). Boys who have Hypospadias are also more prone to urinary tract infections due to a short urethra. Hypospadias may be associated with infertility to some extent as the urethral opening might be too far off on the shaft of the penis and may make it difficult for the semen to be ejaculated in to the vagina.
After spending a couple of hours in the recovery room, your child will be brought back to room and he can be fed now. There will be a large dressing on the penis and a catheter will be inserted for the urine to drain from the urethra following Hypospadias repair.
There will be pain and soreness after the surgery, your surgeon will prescribe medication for pain relief. Keep the dressing dry and clean to avoid infection at the incision site.
Do not give your child a bath after the Hypospadias repair until the dressing comes off. You will be instructed to come back to the hospital after a week to get your child’s dressing and catheter removed. Your child’s penis may look red and swollen which will settle down within the next few weeks.
The chances of postoperative complications will most likely increase if Hypospadias repair is performed on an adult. Amongst other problems, the most outstanding one is decreased sex drive and sexual activity which can be considered to be the most serious one.
The goal of the Hypospadias surgery is to permit urination standing up and to have satisfactory sexual relationships. Surgeons specializing in uro-genital surgery use best of techniques to give the penis an appearance which comes as close as possible to the normal looking one. In these techniques, a urethral meatus is created on the tip and the penis has a circumcised appearance.
Hypospadias repair can improve the appearance as well as the functional problems of your child like urination, sexuality and reproduction. Hypospadias repair surgery straightens the penis especially during erection, re-positions the opening of urethra, urination is possible in a straight stream and of course your child’s penis is normal in appearance.