Hypospadias

This birth defect is characterized by the urethra opening not being at the tip of the penis, but on the underside. This is a common condition, occurring in approximately 1 in 250 live male births, and there are treatment options that ensure that males can have normal reproduction and urination.

If your infant has hypospadias, talk to your doctor. They can evaluate your child and let you know which treatment options are available. If there is concerns for possible hypospadias after birth, routine newborn circumcision should be deferred until the patient is evaluated by a pediatric urologist.

This condition is considered to be due to abnormal penile development and it is present when the child is born. As a male fetus develops in the womb, the formation of the foreskin and urethra is due to hormone stimulation. When the action of these hormones malfunction, hypospadias can result and usually occurs early during the pregnancy, and will not resolve or worsen with time after birth.

The cause of this condition is typically unknown. However, there are some risk factors that may increase a child’s risk:

• There is a family history of hypospadias
• Possible gestational diabetes or diabetes in the mother
• Certain gene variations may disrupt the hormones that are responsible for stimulating male genital formation
• During pregnancy, exposure to certain substances may increase the risk, such as hormones, industrial chemicals, or pesticides

With most cases of hypospadias, the urethra opening is still within the penis’ head. However, there are cases where this opening is either at the base of the penis or near the middle. In rare instances, the opening is below or in the scrotum. The symptoms may include:

• The penis has a downward curve
• During urination, urinary stream is abnormal
• The foreskin of the penis has a hooded appearance due to the foreskin only covering the top half

If this condition is left untreated, there may be some associated problems, such as:

• Issues learning to use the toilet in a standing position
• Problems with impaired ejaculation
• Abnormal penile appearance
• When an erection occurs, the penis may have an abnormal curvature

• In some cases, surgery is not necessary if the hypospadias is very minor. However, surgery is the usual course of treatment.
• Surgery works to reposition the opening of the urethra. In some cases, the surgeon will also straighten the penile shaft. In most cases, the surgery is performed when the baby is 6 to 12 months old.
• When the opening is very low, especially if close to the penile base, a tissue graft might be necessary to reconstruct the urinary channel.