Hypospadias - Children's Hospital Boston

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My Child Has:

Hypospadias

Programs that treat this condition

Center for General Pediatric Urology

What is hypospadias?

Hypospadias is a congenital defect in which the urethral opening (pee hole) is not located at its normal position at the tip of the penis. In its mildest form, the opening is just on the underside of the penis near the tip. In its more severe form, it may be located at the base of the scrotum.

How often does hypospadias occur?

Hypospadias appears to be on the rise. Approximately one boy in every 250 will have hypospadias.

What causes hypospadias?

Hypospadias is a congenital (present at birth) abnormality, which means that the malformation occurs during fetal development, but its exact cause is not known. As the fetus develops, hypospadias occurs when there is incomplete closure of tissue on the undersurface of the penis, known as the urethral folds, which form the urethra.

What are the symptoms of hypospadias?

The following are the most common symptoms of hypospadias. However, each child may experience symptoms differently. Symptoms may include:

abnormal appearance of foreskin and penis on exam
abnormal direction of urine stream
the end of the penis may be curved downward

The symptoms of hypospadias may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

How is hypospadias diagnosed?

Hypospadias is usually diagnosed just after birth during a baby's first physical examination. The baby will be referred to a pediatric urologic surgeon. The location of the defect dictates how severe it is. A diagnosis can fall into one of the following categories:

Anterior (distal): hypospadias in its the mildest form; includes defects at the glanular, coronal and subcoronal levels; occurs in 50 percent of cases.
Middle: moderate hypospadias; includes defects at the distal penile shaft, mid-penile shaft and proximal penile shaft levels; occurs in 30 percent of cases
Posterior (proximal): most severe hypospadias; includes defects at the penoscrotal junction, scrotal and perineal levels; occurs in 20 percent of cases

Treatment Options

Some minor defects may not require repair as they will not affect future sexual function or procreative ability. If surgery is to be performed, the ideal age range for hypospadias repair is approximately from 4 to 18 months. The surgeon's ultimate goal is to create a straight penis with the opening (urethral meatus) at the tip of a penis. There are various types of surgical techniques used to correct hypospadias and you should discuss these with your doctor. Regardless of the surgical technique, the following aspects of repair should be addressed:

orthoplasty: straightening of the penis if curvature is present
urethroplasty: formation of the new urethral tube (neourethra) from the level of the defect to the tip of the penis
meatoplasty: creation of a slit-like opening for the urethra at the tip of the penis
glanuloplasty: coverage of the very end of the neourethra by bringing together glans tissue in the midline
skin coverage: coverage of the penis with local or repositioned penile skin

Surgery is typically performed with the assistance of a general anesthetic. A local or regional anesthetic is also administered during the procedure in order to minimize postoperative discomfort. Sutures used for the repair eventually dissolve. With most techniques, a soft drainage catheter is left within the neourethra for approximately 7-10 days following surgery. This allows urine to drip into the diaper and initial healing to take place without the need for the baby to void urine over the fresh repair site.

The use of optical magnification, meticulous surgical technique, and proper handling of delicate tissues are important aspects of successful surgery. Complete repair is typically performed with one surgical procedure. However, some of the more severe hypospadias defects require a "two-stage" repair. The first stage involves straightening of the penis, if necessary, and repositioning of penile skin in preparation for formation of the neourethra at the second stage. The second stage is performed approximately six months after the first.

Depending on the extent of surgery, the baby may either go home on the day of surgery (following successful recovery from anesthesia) or stay in the hospital one night for observation. Following the surgery the caretaker is asked to apply an antibiotic ointment to the penis several times each day. A small daily dose of antibiotic may be prescribed to decrease the risk of infection and acetaminophen should be given for pain management. The patient and repair are typically reevaluated one and then several months following surgery.



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