Hypospadias

Hypospadias is a birth defect. The opening of the urethra is not in its usual place. The urethra is the tube that empties urine from the bladder to the outside of the body. In mild cases, the urethra opens close to tip of the penis. In other cases, the urethra opens just below the ridge of the penis. It can also occur in the middle of the shaft or base of the penis. Less often, it opens on or behind the scrotum. Children with hypospadias can also have:

  • Part of the foreskin absent, giving a hooded or incomplete appearance.

  • A downward curve to the erect penis (chordee).

CAUSES

Hypospadias is a common problem. The cause is not known. It may be passed down from parent to child (hereditary).

SYMPTOMS

The symptoms of hypospadias in boys depend on the location of the defect. In mild cases, there may be no symptoms. In other cases, common symptoms are:

  • Passing urine in abnormal directions or spraying.

  • Curved penis with erections (erections are common and normal in infancy).

  • Larger than normal urethral opening.

Untreated hypospadias can have the following symptoms:

  • Needing to sit down to pass urine because of spraying or abnormal stream direction.

  • Difficulty with toilet training.

  • Embarrassment about being different in his appearance.

  • Problems with sexual intercourse and fertility.

  • Painful erections.

DIAGNOSIS

The diagnosis is usually made during a physical exam. However, hypospadias may be discovered during a routine circumcision. If the hypospadias is severe, the caregiver may recommend further testing. These tests include an ultrasound, X-rays, or blood tests to rule out problems like kidney and other birth defects.

TREATMENT

Surgery is the only treatment to correct the problem. It is best done before 18 months of age. The goal of surgery is to create a normal urethra and urethral opening. Curvature of the penis is corrected to allow for normal sexual intercourse and fertility. The penis is made to look normal. More than 1 surgery is sometimes needed. Circumcision should not be done at birth or before hypospadias surgery. The foreskin is usually needed during the corrective surgery.

HOME CARE INSTRUCTIONS

An older boy may be embarrassed or upset when he becomes aware of his untreated hypospadias. He will need support and understanding to cope. After surgery, home care instructions specific to the type of surgery will be provided.

SEEK MEDICAL CARE IF:

  • Your child has an oral temperature above 102° F (38.9° C).

  • Your baby is older than 3 months with a rectal temperature of 100.5° F (38.1° C) or higher for more than 1 day.

  • Your older child has signs of urinary tract infection.

  • Painful or frequent urination develops.

  • Urinary accidents happen.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.