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Hypospadias

Hypospadias is a birth (congenital) defect in which the opening of the urethra is on the underside of the penis. The urethra is the tube that drains urine from the bladder. In males, the opening of the urethra is normally at the end of the penis.

Causes, incidence, and risk factors

Hypospadias occurs in up to 4 in 1,000 newborn boys. The cause is often unknown.

Sometimes, the condition is passed down through families.

Symptoms

Symptoms depend on how severe the problem is.

Usually, boys with this condition have the opening of the urethra near the tip of the penis on the underside.

More severe forms of hypospadias occur when the opening is in the middle or base of the penis. Rarely, the opening is located in or behind the scrotum.

This condition may cause a downward curve of the penis during an erection. Erections are common in infant boys.

Other symptoms include:

  • Abnormal spraying of urine
  • Having to sit down to urinate
  • Foreskin that makes the penis looks like it has a "hood"

Signs and tests

This problem is almost always diagnosed soon after birth during a physical exam. Imaging tests may be done to look for other congenital defects.

Treatment

Infants with hypospadias should not be circumcised. The foreskin should be kept 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 opening is corrected using tissue grafts from the foreskin. The repair may require multiple surgeries.

Expectations (prognosis)

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

Most males can have normal adult sexual activity.

Calling your health care provider

Call your health care provider if your son has:

  • A curved penis during an erection
  • Opening to the urethra that is not on the tip of the penis

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. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 538.

Snodgrass WT. Hypospadias. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 130.   

Updated: 10/9/2012

Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine; Louis S. Liou, MD, PhD, Chief of Urology, Cambridge Health Alliance, Visiting Assistant Professor of Surgery, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.


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