Hypospadias

What is hypospadias?

In hypospadias, the opening of a boy’s urethra (through which both urine and semen pass) is located on the underside of the penis rather than at the tip. This condition, which is present at birth, affects about 1 in 200 boys. While very mild forms of hypospadias may not interfere with urinary or reproductive function, most boys with the condition will require surgery. The outlook for infants who undergo this operation is extremely good: In most instances, they make a full recovery and have a normal-looking, fully functional penis within about six months.

What are the symptoms of hypospadias?

In hypospadias, the urethral opening can be located at any point along the underside of the penis. The location of the opening determines the severity of the condition. In anterior or distal hypospadias, the urethral opening is located near the tip of the penis. This is the mildest form of hypospadias, occurring in about 50 percent of cases. Middle hypospadias means that the opening is located midway up the penis and accounts for about 30 percent of cases. In the most severe form of the condition, known as posterior or proximal hypospadias, the opening develops at a boy’s scrotum or perineum and occurs in 20 percent of cases.

Other signs of hypospadias include:

  • downward urinary spray (in older boys with more severe hypospadias, this may mean they have to sit down to urinate)
  • downward curve of the penis, called chordee
  • “hooded” appearance to the penis, caused by extra foreskin along the top side
  • abnormal appearance of the tip of the penis (the glans)

In some cases, boys born with hypospadias may also have undescended testicles, inguinal hernias or both.

Hypospadias doesn’t cause physical pain or block urination, but left untreated, more severe forms can interfere with sexual intercourse in adulthood.

What causes hypospadias?

Hypospadias is a congenital condition, meaning that it happens while the baby is developing in the mother’s womb. As the fetus develops, the tissue on the underside of the penis that forms the urethra doesn’t close completely, shortening the passageway. In many cases, the foreskin — the fold of skin covering the penis tip, or glans — also doesn’t develop properly, resulting in extra foreskin on the top side of the penis and none on the underside.

There is no known cause of hypospadias. Researchers do know, however, that it appears to run in families: Hypospadias is slightly more common in boys whose father or brother also had the condition.

How we care for hypospadias

The clinicians at Boston Children’s Hospital have extensive experience in caring for boys with hypospadias and see more than 300 children with this condition every year. We combine compassionate patient care with the latest techniques and surgical techniques to treat children with hypospadias — one reason why Boston Children’s Department of Urology is consistently ranked as one of the best among pediatric hospitals in the U.S.