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Hypospadias

Definition

Hypospadias is a birth (congenital) defect in which the opening of the urethra is on the underside, rather than at the end, of the penis.

See also: Epispadias

Causes, incidence, and risk factors

Hypospadias affects up to 4 in 1,000 newborn boys.

Some cases are passed down through families. In other cases the cause is unknown.

Symptoms

The condition varies in severity. In most cases, the opening of the urethra is located near the tip of the penis on the underside. More severe forms of hypospadias occur when the opening is at the midshaft or base of the penis. Occasionally, the opening is located in or behind the scrotum.

Males with this condition often have a downward curve (ventral curvature or chordee) of the penis during an erection. (Erections are common with infant boys.)

Other symptoms include:

  • Abnormal spraying of urine
  • Having to sit down to urinate
  • Malformed foreskin that makes the penis look "hooded"

Signs and tests

A physical examination can diagnose this condition. Imaging tests may be needed to look for other congenital defects.

Treatment

Infants with hypospadias should not be circumcised. The foreskin should be preserved for use in later surgical repair.

Surgery is usually done before the child starts school. Today, most urologists recommend repair before the child is 18 months old. Surgery can be done as young as 4 months old. During the surgery, the penis is straightened and the hypospadias is corrected using tissue grafts from the foreskin. The repair may require multiple surgeries.

Expectations (prognosis)

Results after surgery are typically good. In some cases, more surgery is needed to correct fistulas or a return of the abnormal penis curve.

Complications

If hypospadias is untreated, a boy may have difficulty with toilet training and problems with sexual intercourse in adulthood. Urethral strictures and fistulas may form throughout the boy's life, requiring surgery.

Calling your health care provider

Typically a child is diagnosed with hypospadias shortly after birth. Call your health care provider if you notice that your son's urethral opening is abnormally located or that his penis becomes curved during erection.

References

Kraft KH, Shukla AR, Canning DA. Hypospadias. Urol Clin North Am. 2010. 37:167-81.

Elder JS. Anomalies of the penis and urethra. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 544.

Borer JG, Retik AB. Hypospadias. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 125.


Review Date: 9/3/2010
Reviewed By: Linda Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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