Hypospadias

Hypospadias is a common birth defect of the penis. Usually, the urethral opening (the opening of the tube that carries urine out of the penis) appears at the very tip of the head (or glans) of the penis. In hypospadias, the opening can appear anywhere on the underside of the penis. In a mild case of hypospadias, the opening may be just below the head of the penis (coronal). In more severe cases of hypospadias, the opening can be anywhere from the middle of the underside of the penis (mid-shaft) to below the place where the penis and scrotum meet (perineal). Frequently there is a downward curving of the penis called chordee. This curvature may be more pronounced when the penis is erect. The foreskin is also incomplete and has the appearance of a dorsal hood (skin covering only the top and sides of the head of the penis).

How often does hypospadias occur?
This is a relatively common condition that occurs in approximately one out of every 300 male births. Most cases of hypospadias (approximately 90%) are of the milder type.

What causes hypospadias?

The urethra (tube that caries urine) is formed between the 6th and 14th week of pregnancy. There is evidence that in some cases a lack of male hormone produced by the fetus may cause the urethra to stop growing before it reaches its full length. However, in most cases no cause is identified. Hypospadias is not usually caused by anything the parents did or did not do during pregnancy. (In rare cases, progesterone taken by the mother early in pregnancy may cause hypospadias.)

How will this affect my child?

In mild cases, there is little effect from hypospadias. In more severe cases, because the unusually placed opening of the hole will force urine to spray downwards, a boy will find it difficult or even impossible to urinate from a standing position. If chordee is involved, an adult male may have difficulty with sexual functioning due to the curvature of the penis. Unless the hypospadias is very severe, the hypospadias should not affect a man’s fertility. The hypospadias does not affect the ability to hold and release urine, nor will it result in more urinary infections. However, the appearance of the foreskin can be a source of embarrassment or self-consciousness.

Treatment: What can be done?

In mild cases, surgery is optional, based on an evaluation of the urinary stream, the straightness of erections and the way it looks. In moderate to severe cases, surgery is almost always recommended to establish normal function. The goal of surgery is first to straighten out any curvature of the penis and second to remake the part of the urethra that didn’t form. Except for the most severe cases, hypospadias can be corrected in one operation as an outpatient. Depending on the severity of the problem, a second more minor procedure may be needed about 6 months later in 5 to 25% of cases to correct a small leak or a narrowing.

What is this type of surgery like?

There are several surgeries that are available to correct this anomaly. The choice of surgery is based on multiple factors, including the position of the urethral opening, the appearance of the glans, the severity of the chordee, the surgeon’s preference, etc. The penis needs to be straight during erection. This is done primarily by releasing fibrous bands on the underside of the penis (ventral aspect). Sometimes this is not sufficient and more elaborate surgery is needed. Once the penis is straight, the urethra may need to be lengthened. The foreskin can be used for this purpose. The foreskin is also used to recover the ventral skin defect (on the underside of the penis). The need for urine drainage and stenting (inserting a catheter) as well as the length of time of this drainage depends upon the techniques used and the severity of the hypospadias.

When will my son be scheduled for this surgery?

Surgical correction is best done when anesthesia is safe and the penis is large enough. Most surgeons will recommend performing the procedure at an early age so that a child will not have a memory of the experience. Generally this is when the child is between 6 and18 months. Frequently, the surgery can be done as outpatient procedure, which means that your son will not have to stay overnight at the hospital. The alternative is to wait until the child is old enough to make his own informed decision about surgery. However, the risks of complications related to the surgery are higher in adults than children.

How long will the surgery take?

The length of the surgery depends on how curved the penis is and exactly where and how low the opening is on the penis. Most operations take between 1 and 3 hours.

How will hypospadias affect my son in the future?

If your son has his hypospadias repaired surgically, it is likely that the penis will function normally. He will be able to urinate from a standing position and will be able to engage in normal and comfortable intercourse. Recent research studies find that surgically corrected hypospadias should not be considered as a risk factor for poor psychosocial adaptation in childhood. However, repeated genital surgeries may slightly increase the risk of emotional problems.

Studies of boys who had surgery for hypospadias repair show no differences in the average ages at which various sexual milestones (such as kissing, necking and sexual intercourse) were reached as compared to boys without hypospadias repair. However, the condition or its surgical repair may be associated with greater self-consciousness and dissatisfaction with the appearance of the penis. This observation, together with the knowledge that boys and men with hypospadias are sometimes unwilling to seek advice on their own when they experience difficulties, suggests that combining surgical management with psychological counseling might be helpful. This applies mainly to the more severe forms of hypospadias. For older children, the availability of a mental health professional who is introduced to the child during the period of surgery and follow-up may lessen the perceived stigma associated with seeking out counseling when it would be useful.


Adapted from: MAGIC Foundation