Hypospadias Symptoms & Causes

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We understand that you may have a lot of questions when your child is diagnosed with hypospadias, such as:

  • What is it?
  • What are the treatments?
  • How will it affect my child long-term?

We’ve tried to provide some answers to those questions here, and when you meet with our experts, we can talk with you more about your child’s specific situation.

If your son has hypospadias, it means that the opening of his urethra (through which both urine and semen passes) is located under the penis rather than at the tip.

In hypospadias, the urethral opening can be located at any point along the underside of the penis (also called the “ventral aspect”). Where the opening falls will determine how severe the condition is, and how your child’s medical team will approach repairing it.

  • Anterior or distal (near the tip of the penis): This is the mildest form of hypospadias, occurring in about 50 percent of cases.

  • Middle (midway up the penis): Considered moderate hypospadias, this accounts for about 30 percent of cases.

  • Posterior or proximal (at the scrotum or perineum): This is the most severe kind of hypospadias, and occurs in 20 percent of cases.

Some parents may confuse hypospadias with epispadias, in which the urethra opens along the top of the penis, but these are two separate and distinct conditions with very different treatments.

Complications

If left untreated, more severe forms of hypospadias can interfere with sexual intercourse when your child is an adult.

Causes

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 completely close, 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.

Hypospadias isn’t brought on by anything that parents do, or fail to do, during pregnancy. In fact, even though the number of cases has been on the rise since the 1970s, there’s 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.

Signs and symptoms

The number one sign of hypospadias is that your son’s urethra is located on the underside of his penis, as opposed to the tip. Other signs that you might see in your child include:

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

In some cases, boys born with hypospadias may also have undescended testicles and/or inguinal hernias (that is, hernias of the groin).

FAQ

Q: How will I know if my baby has hypospadias?
A:
While it’s possible for physicians to detect signs of severe hypospadias on a fetal ultrasound, the vast majority of children are diagnosed at birth.

Q: Is hypospadias painful?
A:
This condition won’t cause your son physical pain or block his urination (though if it goes untreated it can make it difficult for him to direct his urine spray).

Q: Do all boys with hypospadias need surgery?
A:
If your son has a very mild case, he may not require surgery because his condition will not have a large impact on his life. However, sometimes parents of boys born with minor abnormalities still opt for surgery for cosmetic reasons.

Q: Are there any medical alternatives to surgery?
A:
No, surgery remains the best and only way to resolve your son’s urinary difficulties; to straighten and repair his penis so it will look more normal; and to help ensure that he will have full sexual function as an adult.

Q: When should the operation be scheduled?
A:
This depends on what kind of hypospadias your child has, and whether he was diagnosed at birth (most boys are). Typically, if he requires surgery, we recommend that it be scheduled when he is between 4 and 6 months old.

Q: What kind of care will my son need after surgery?
A:
This depends on whether your child is diagnosed at birth, and how severe his hypospadias is. But if he’s like the vast majority of boys that Children’s treats—infants ages 4 to 6 months who undergo a one-step operation—you’ll be able to take him home on the same day of the surgery. Our nurses will teach you how care for your son at home while he heals.

Q: Will this affect when and whether my son will be circumcised?
A:
Babies who have hypospadias that requires surgery shouldn’t be circumcised, because the foreskin may be needed for tissue grafts during the operation.

Q: If my son’s hypospadias doesn’t require surgery for medical reasons, can it still be done to make his penis look more normal?
A:
Yes—surgeons will often perform hypospadias repairs for more “cosmetic” reasons, like straightening the penis and removing excess foreskin.

Q: Will this affect when and how I potty-train my son?
A:
At Children’s, we believe that the best window for hypospadias surgery is between 4 and 6 months, which means your son will have healed well before the age of potty-training.

Q: How soon after surgery will my son’s penis looks like other little boys’?
A:
It varies from patient to patient, but typically you’ll be able to see the full results of your son’s surgery after six months.

Useful medical terms

Anterior hypospadias: The mild form of hypospadias, in which the urethra opens beneath the tip or upper shaft of the penis. Also called distal hypospadias.

Chordee: An abnormal downward curve of the penis, especially during erection.

Circumcision: Removing all or part of the foreskin from the penis.

Congenital: Present at birth.

Dorsal hood: Incompletely formed foreskin that covers the top (dorsal) part of the penis but leaves the underside (ventral) part exposed.

Foreskin: The loose fold of skin that covers the head of the penis.

Glans: The bulblike tip of the penis. Also called the glans penis.

Meatus: The opening of the urethra.  

Middle hypospadias: The moderate form of hypospadias, in which the urethra opens beneath the midshaft of the penis. Also called midshaft hypospadias.

Orthoplasty: Surgical straightening of the penis.

Posterior hypospadias: The severe form of hypospadias, in which the urethra opens beneath the base of the penis or behind the scrotum. Also called proximal hypospadias.

Stent: A narrow, soft artificial tube placed in the new urethra to hold it open during healing. Also called a catheter.

Urethra: A tube that carries urine from the bladder to the tip of the penis; it also carries semen from the prostate to the tip of the penis.

Urethroplasty: The surgical creation of a new urethra (neourethra).

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- Sandra L. Fenwick, President and CEO

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