Hypospadias (hi-poe-SPAY-dee-us) is an abnormality of the penis in which the opening of the urethra (the tube which drains urine during voiding) is located on the underside of the penis, instead of at the tip of the penis.

Hypospadias is a common birth defect.  There is no additional care needed for infant boys diagnosed with hypospadias.   

In hypospadias severity of the condition can varies. In most cases, the opening of the urethra is near the head of the penis. However, the opening can be located at various locations along the underside of the penis and occasionally my open at the base of the penis.  Rarely, the opening is located in the scrotum or beneath the scrotum.

Hypospadias may be associated with other findings such as:

  • Penile chordee :  A downward curve of the penis
  • Dorsally hooded foreskin:  The penile foreskin covers only the top of the penis giving a hooded appearance
  • Abnormal stream of urine:  Urine may spray or the urinary stream may not be straight

Typically, infants are diagnosed with hypospadias soon after birth.  If your child is diagnosed with hypospadias, a circumcision should not be performed because the foreskin tissue may be needed for repair.  

Sometimes, mild hypospadias may be overlooked. Occasionally, it is possible for a boy to have a normal foreskin that covers the hypospadias.  If this occurs, hypospadias may be diagnosed after your child is circumcised.

Hormones are important for the penis to develop normally.  Balanced hormones stimulate the formation of the urethra and foreskin.  Absence of hormones or imbalance of the hormone levels can upset normal development.  This results in the abnormal urethral position on the penile shaft and the abnormal foreskin that may occur with hypospadias. 

The exact cause of hypospadias is unknown but both environmental and genetic factors are important.  Examples include:

  • Family history.  Hypospadias is more common in families with a family history of the condition. 
  • Maternal age over 40. Some researchers have found that hypospadias may be more common in children born to mothers over the age of 40. 
  • Exposure to smoking and chemicals.  Some research has suggested that maternal exposure to pesticides and other factors may result in hypospadias but more research is needed to confirm these findings.
  • Assisted reproductive techniques.  Studies have found that use of assisted reproductive techniques may be associated with prematurity, low birth weight and multiple gestations.  All of which are associated with hypospadias.  If you are planning to utilize assisted reproductive techniques, ask your doctor about risk factors for hypospadias and other malformations.

If hypospadias is very mild, it may not need treatment.  However, we recommend that you discuss this with your doctor or seek evaluation by a pediatric urologist who will help you make decisions about treatment options. 

If the hypospadias is mild, moderate or severe, the child may have problems with toliet training due to urinary spraying and deviated stream.  During adulthood, untreated hypospadias can cause difficulty in achieving a normal erection and can contribute to infertility.

If your infant son is diagnosed with hypospadias just after birth and while still in the hospital after birth, you will receive a referral to a pediatric urologist.

If your child's hypospadias was overlooked in the hospital or if you think your son has hypospadias, call your family doctor or pediatrician.  They will evaluate your child and if necessary, provide a referral to a pediatric urologist.

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.

Surgery is required to reposition the urethral opening to the tip of the penis, if necessary straighten the shaft of the penis and correct or remove the dorsal hooded foreskin

During surgery, a pediatric urology surgeon uses tissue from the foreskin, the penile shaft, the scrotum and rarely from the inside of the mouth to reconstruct the urethral channel and bring the opening to the tip of the penis.  The surgery usually takes from one to four hours and is done while the child is under general anesthesia. If the hypospadias is severe and the penis is severely curved (severe chordee), the repair may require more than one surgery.

It is best to do surgery between 6 and 18 months. The procedure can be at any age, including into adulthood.

In most cases, surgical repair results in a penis with a normal or near-normal function and appearance with no immediate or long-term problems.  In some cases, a hole (fistula) may develop between the skin and the new urethral channel.  This can result in urine leakage and require an additional surgery for repair.  Sometimes the opening scars and becomes small (meatal stenosis) after repair resulting in urinary spraying.  This requires a minor procedure for repair.

If your son has hypospadias and requires surgical repair, you may feel worried and anxious. The good news is that the surgery for hypospadias is usually very successful, and your very young child will probably not recall having the procedure.

When you arrive for your appointment with your pediatric urologist, here is some information that may help you prepare:

  • Both parents should attend the appointment if possible.  If not, ask a family member or friend to come with you. Someone who accompanies you may remember something that you missed or forgot.
  • Write down questions to ask your doctor.
    • Questions often include:
      • Does my child need to have surgery?  If so when?
      • What are the risks associated with this surgery?
      • Are there options besides surgery?
      • How will this affect my child later in life?

UNC Pediatric Urology is dedicated to providing your child with quality state-of-the-art care.  If you would like to make an appointment to see one of our pediatric urology specialist, please call: 919-966-1401