Hypospadias is one of the most common birth defects. The Centers for Disease Control and Prevention reports that this abnormal development of the urethra affects about one in every 200 male babies in the United States.
Cases of hypospadias can range from minor to severe. The exact cause of hypospadias is unknown.
The condition doesn’t mean there are other flaws in the urinary system or other organs. But if left untreated, hypospadias could lead to problems in adulthood. Surgical repair of hypospadias results in normal urination, sexual activity, and reproduction.
What Is Hypospadias?
Hypospadias is a birth defect of the urethra (the tube that carries urine out of the body) that occurs only in males. In babies born with hypospadias, the urethra opening — known as the urethral meatus — is not located at the tip of the penis. Instead, the opening of the urethra is anywhere from just below the end of the penis to the scrotum.
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What Causes Hypospadias?
The cause of hypospadias is unknown in most cases. However, researchers found evidence that genetics and environmental factors play a role.
In about 7 out of 100 cases, the child’s father was born with hypospadias. Researchers also found the following genetic links in hypospadias cases:
- If one child has hypospadias, the chances that a second son will be born with it are about 12 out of 100.
- If both the child’s father and brother have hypospadias, the risk that a second son will have hypospadias is 21 in 100.
Environmental factors during pregnancy — such as food, drink, and medicines consumed by the mother — also may increase the risk of hypospadias. Other maternal factors that could increase the risk are:
- Being age 35 or older plus having a BMI greater than 26 (overweight or obese)
- Having fertility treatments
- Taking certain hormones (such as progestins) just before or during pregnancy
Hypospadias is typically diagnosed during a physical exam at birth. A medical provider would notice the meatus is not located at the tip of the penis. Another indicator is abnormal foreskin, such as foreskin that is not completely formed on its underside.
In some cases, the penis also curves downward slightly, called chordee. More than 50% of babies born with hypospadias also have a curved penis when the meatus is farther down the shaft.
Surgery is often recommended to correct hypospadias. There are four main steps to this operation:
- Straighten the shaft
- Create a urinary channel
- Position the meatus at or near the tip of the penis
- Circumcise the penis (tissue below the
foreskin is used to cover the urinary channel)
Children of any age and even adults may undergo hypospadias surgery. But surgeons prefer to do hypospadias surgery in children between the ages of 6 six and 12 months. Younger children have less discomfort after surgery, and a child is less likely to remember.
Doctors may recommend testosterone treatment before surgery if the patient’s penis is narrow. Successful repair should last a lifetime — even as the penis grows during puberty. More severe versions of hypospadias — those with a urethra near the scrotum or curvature more than 30 degrees — typically require at least two surgeries for successful repair.
How Long Does It Take to Heal After Hypospadias Surgery?
Many surgeons leave a catheter in the penis for a few days after surgery so urine doesn’t contact the repair site. Antibiotics are often prescribed. Swelling and bruising can occur early on, and medicines may be prescribed to treat bladder spasms. Most swelling from surgery goes down over the first six weeks; complete wound healing from surgery occurs within six months.
Complications From Hypospadias Surgery
The most common complication after surgery is a hole — or fistula — forming in another place on the penis. This occurs when a new path forms from the urethra (reconstructed urinary channel) to the skin. Scars may form in the channel or the meatus, which can interfere with urination. Patients should see their health care provider if:
- Urine leaks from a second hole
- A urinary
tract infection develops after surgery
- They experience a slow or spraying urinary stream over time
Most complications occur in the first few months after surgery, but fistulas or blockages sometimes develop over the years. That’s why it is important to follow up with your child’s urologist after potty training and ideally at puberty to ensure a boy is satisfied with the surgical outcome and that erections are straight.
Is Surgery Necessary?
Although it’s impossible to know how hypospadias may affect a child later in life, surgery can help prevent future issues.
- There is a risk of penis curvature with hypospadias. When the curve is severe, it can interfere with sexual intercourse after puberty.
- In hypospadias, the meatus is often too large, too small, or has a web of skin just beyond the opening. Such abnormalities can affect the urine stream and cause spraying. Although less common, very small
openings can obstruct the urinary tract and cause damage over time.
- A partly formed foreskin will always appear abnormal and can draw attention to hypospadias, although this is only a cosmetic concern.
National Center on Birth Defects and Developmental Disabilities. Facts about Hypospadias. Centers for Disease Control and Prevention (CDC). Link.
American Urological Association. What is Hypospadias? Urology Care Foundation. Link.
Archives of Pediatrics & Adolescent Medicine. Maternal Progestin Intake and Risk of Hypospadias. Link.
Paediatric and Perinatal Epidemiology. Maternal reproductive and demographic characteristics as risk factors for hypospadias. Link.
Sexual Development. The Genetic and Environmental Factors Underlying Hypospadias. Link.
The UPMC Department of Urology offers a wide variety of specialized care for diseases of the male and female urinary tract and the male reproductive organs, including erectile dysfunction, kidney stones, urinary incontinence, prostate cancer, and more. We have a multifaceted team of physicians and researchers working together to provide the best care to both children and adults. Our team is nationally renowned for expertise in highly specialized technologies and minimally invasive surgical techniques. To find a provider near you, visit our website.