Hypospadias

Hypospadias Causes and Risk Factors

Hypospadias occurs while the baby is developing in utero. The tissue on the underside of the penis that forms part of the urethra doesn’t fully close, and the foreskin doesn’t develop fully. This leaves extra foreskin on the top of the penis and no foreskin on the underside, causing curvature of the penis.

Some possible risk factors for hypospadias include:

• Mother is age 35 or older.
• Mother had gestational diabetes while pregnant.
• A family history of urinary or genital disorders.
• Premature birth.
• Low birth weight.
• Baby is a twin.
• Exposure to secondhand smoke or pesticides in utero.

Hypospadias Symptoms

Some common symptoms of hypospadias include:

• Abnormal appearance of foreskin and penis.
• Abnormal urine stream.
• Penis curves downward (a condition called chordee).
• Penis has hooded appearance.

If not treated, hypospadias may cause complications such as:

• Urine stream that points or sprays in an abnormal direction or several directions.
• Penis may develop a curvature as it grows, leading to sexual problems in the future.
• Fertility issues: the abnormal location of the urethra opening may make ejaculation difficult.

Hypospadias Diagnosis and Treatment

Your child’s pediatrician can diagnose hypospadias during a physical exam at birth. They will likely refer you to a pediatric urologist for further evaluation and treatment.

In some cases, the form of hypospadias is minor and will not require major surgery. However, treatment often involves one or more surgeries to move the opening of the urethra to the tip of the penis. This surgery is usually done when the baby is 6 –18 months old. Surgery may also be done to straighten the penis if it is curved to give it a more normal appearance.

If a baby is diagnosed with hypospadias at birth, he will likely not be circumcised. Instead, the foreskin will be left in place to be used during surgery to help repair the penis so that it looks and functions properly.

Post-Surgery and Follow-Up Care

In most boys and men, surgery to repair hypospadias is very successful, correcting the flow of urine and giving the penis an anatomical appearance. Successful treatment will also improve the patient’s possible future fertility. Potential complications of surgery include formation of a hole (fistula) on the underside of the penis that may result in urine leakage. There could also be a problem with wound healing or scarring, but this is rare. If needed, another surgery may be performed to correct these issues.

After surgery, follow-up care with your child’s pediatric urologist until puberty is recommended to check that the repair is healing properly and to monitor for potential complications.