Hypospadias

Hypospadias at a glance

  • Hypospadias is a condition that affects male infants in which the urethra opens on the underside of the penis instead of at the tip.
  • Hypospadias is a fairly common, usually easily treatable birth defect in boys that causes curved erections and problems directing the urine stream.
  • Doctors can correct hypospadias with a surgical procedure.

What is hypospadias?

Hypospadias is a birth defect in infant boys where the urethra (the tube that carries urine out of the body) does not open at the tip of the penis. Instead, the opening appears on the underside of the penis, most often near the head of the penis. Less frequently it is lower on the shaft of the penis. Rarely the urethra opens in or beneath the scrotum.

Hypospadias is concerning for parents, but it is fairly common. The condition occurs in approximately one in 200 infant males, making it one of the most frequent birth defects of the male genitals. Mild hypospadias probably will not cause problems for newborns and young children.

Hypospadias does not make it difficult to care for an infant, and it is unlikely to cause lasting negative effects. Hypospadias often occurs with chordee, which is a curvature of the penis.

More severe hypospadias can create problems directing the urine stream that can be embarrassing and cause hygiene issues. It can also result in curved erections that can lead to sexual problems in older boys and men. Some boys or men with hypospadias might be unable to urinate while standing because of these issues.

Causes of hypospadias

Doctors do not completely understand the cause of hypospadias. Several potential factors may be related to hypospadias. These include:

  • Hormonal conditions. Hypospadias appears to be more likely if the mother is treated with progesterone during pregnancy. Some researchers think hypospadias can occur if the fetal testes fail to respond to, or produce enough, testosterone.
  • Hypospadias is more common in infants whose families have a history of the condition.
  • Maternal age over 40. Infants of older mothers appear to have a higher incidence of hypospadias.
  • Environmental conditions. Some studies suggest that environmental exposure to pesticides or smoke might raise the incidence of hypospadias.
  • Infant boys conceived via assistive reproductive technologies are at higher risk for hypospadias. 

Symptoms of hypospadias

Hypospadias often has no symptoms other than the appearance of the penis and urethra.

  • The urethral opening usually is visible somewhere other than on the tip of the penis, usually along the shaft.
  • The penis might curve (chordee).
  • Dorsal hood, in which the foreskin (pre-circumcision) might cover only the top half of the penis resulting in a hooded appearance, can also be an indicator of hypospadias.

Treatment of hypospadias

A doctor or nurse usually identifies hypospadias during the newborn physical examination or routine neonatal circumcision. However, a parent who notices an unusual formation of the infant’s penis should also bring it to the physician’s attention. If this is noted during routine circumcision, the procedure should be stopped and the baby should see a urologic specialist.

If the placement of the urethral opening needs to be corrected, a doctor will recommend surgery. This surgery is usually done before a baby is 18 months old. Performing the corrective surgery at a young age makes it less psychologically traumatic for the child. However, surgery can be performed later if needed.

The surgery may relocate the opening, adjust the position of the urethra and/or reconstruct the skin around the opening of the urethra. During surgery the surgeon might use the foreskin to make repairs, so doctors recommend that a baby with hypospadias not be circumcised. For most cases one surgery is sufficient, but in a few cases the child may require an additional surgery.

Without surgical treatment some adults and older children will experience complications. These could include a narrowed urethra, curvature of the penis, sexual dysfunction and possible infection or bleeding.

After surgical correction most males can urinate while standing up. Surgery also allows most males to have normal sexual function.