Definition

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

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.

Most often, 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"

Exams 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 intact for use in later surgical repair.

In most cases, surgery is 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 several surgeries.

Outlook (Prognosis)

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

Most males can have normal adult sexual activity.

When to Contact a Medical Professional

Contact 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
• Incomplete (hooded) foreskin

References

Chan Y-M, Hannema SE, Achermann JC, Hughes IA. Disorders of sex development. In: Melmed S, Auchus, RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 24.

Elder JS. Anomalies of the penis and urethra. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 559.

Long CJ, Zaontz MR, Canning DA. Hypospadias. In: Partin AW, Domochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 45.