Hypospadias

What is Hypospadias

Hypospadias is a fairly common birth defect in male babies. It occurs when the opening of the urethra is not in the usual place at the tip of the penis.

The urethra is the part of the body that drains urine from the bladder out of the body. In a baby with this condition, the urethra is located on the underside of the penis.

In mild cases of hypospadias, the urethra opens near the tip of the penis. In other cases, the urethra may open below the ridge of the penis, in the middle of the shaft, or at the base of the penis.

Less often, it opens where the penis and scrotum meet. Babies with this condition should not be circumcised as newborns, especially if they need corrective surgery for this condition.

When the penile meatus is located more ventrally and proximally than expected, what is this congenital abnormality called, and what is an associated finding?

Hypospadias is a congenital abnormality in which there is ectopic location of the urethral meatus along the ventral aspect of the penis. A dilated utricle is an associated finding, and in general, the more proximally located the hypospadias is, the larger the utricle is.

What are the causes?

The cause of this condition is not known. It may be passed from parent to child (hereditary).

What increases the risk?

A baby is more likely to have hypospadias if the mother:

• Used fertility treatments to get pregnant.
• Is age 35 or older.
• Is pregnant with more than one baby (multiple gestation).

A baby is also more likely to have this condition if he:

• Was born early (prematurely).
• Is smaller in size at birth compared to other babies (small for gestational age).

What are the symptoms?

Symptoms of hypospadias depend on where the urethra opens. Common symptoms include:

• Passing urine in abnormal directions or spraying. Later in life, this could cause your child to have difficulty urinating while standing, and he may need to sit to urinate.
• The penis curving downward (chordee) when it is erect. Later in life, this could result in difficulty having sex.
• A urethral opening that is larger than normal.
• A hooded appearance at the head of the penis due to missing foreskin. This can leave the tip of the penis exposed.

In some cases, there are no symptoms besides the urethral opening not being in the usual place.

How is this diagnosed?

This condition is diagnosed with a physical exam after birth. You may work with a specialist (pediatric urologist) for diagnosis and treatment.

How is this treated?

If the condition is minor and your baby does not have symptoms, he may not need treatment. However, surgery is often needed to create a normal urethra and urethral opening near the tip of the penis. Surgery:

• Is usually done when a baby is 6–12 months old.
• Involves correcting the downward curve of the penis, if needed. This allows for normal sexual function.
• May consist of more than one procedure over time. The reason for repeating the procedure is to maintain the correct location of the urethral opening as the baby grows.

After surgery, your baby will have follow-up visits with the health care provider for a long time. The health care provider will monitor your child for problems that can develop over time, such as trouble urinating, curving of the penis, or tightening of the urethra (urethral stricture).

Follow these instructions at home:

• Give your baby over-the-counter and prescription medicines only as told by the health care provider.
• Keep all follow-up visits as told by your baby’s health care provider. This is important.

Contact a health care provider if:

• You have questions about corrective surgery.

Get help right away if:

• Your baby has a fever.
• Your baby who is younger than 3 months has a fever of 100°F (38°C) or higher.

Summary

• Hypospadias occurs when the opening of the urethra is not in its usual place at the tip of the penis.
• Babies with this condition should not be circumcised as newborns, especially if they need corrective surgery for this condition.
• There may be no symptoms at all, or your baby may need surgery to create a normal urethra and urethral opening near the tip of the penis.