Hypospadias is a birth defect in boys in which the urethra, the tube through which urine travels from the bladder to outside the body, doesn’t develop properly. The urethra begins as an open channel that gradually closes as the child develops. In babies born with hypospadias, the opening of the urethra forms in another location--on the shaft of the penis or on the scrotum-- instead of on the tip, where it is supposed to be.
Other features seen in boys with hypospadias include the following:
- The penis curves downward (chordee).
- In about 10 percent of the cases of hypospadias, one of the testicles does not fully descend into the scrotum.
- The foreskin (the skin that covers the head of the penis) is incompletely developed.
Hypospadias is a common problem, affecting one of every 150 to 300 newborn boys. If it is not treated, hypospadias can lead to problems later in life, such as having to sit down to urinate, or difficulties with sexual intercourse.
What causes hypospadias?
The specific causes of hypospadias are unknown. However, there is a family trend: fathers and brothers of children with hypospadias are slightly more likely to have the abnormality.
Male and female genitalia are similar during the first eight or so weeks of development in the womb. The penis begins to develop after the eighth week. The defect in the urethra occurs between weeks 9 and 12 of pregnancy.
Certain factors in the mother may lead to an increased risk of hypospadias, including:
- older than 35
- use of fertility treatment to help with conception. This may be a result of the mother’s exposure to progesterone, a hormone used during the fertilization procedure.
- use of other hormones before or during pregnancy
Pregnant women can reduce the risk of hypospadias and other birth defects by practicing healthy behaviors, including:
- not smoking or drinking alcohol;
- maintaining a healthy weight;
- taking 400 to 800 micrograms (mcg) of folic acid a day; and
- seeing the doctor regularly while pregnant.
The incidence of hypospadias appears to be rising in Western cultures. One possible theory for this increase is the use of environmental pollutants, especially hormone-like compounds that are used in pesticides on fruits and vegetables.
How is hypospadias diagnosed?
Hypospadias can be diagnosed with a physical examination when the baby is born. Because it is common, physicians check for hypospadias in all newborns.
The abnormality is easily noticed. Chordee, which often occurs at the same time as hypospadias, is not noticeable and may only be seen when the penis is erect.
The doctor may refer the family to a pediatric urologist to treat the baby.
How is hypospadias treated?
Hypospadias is treated with surgery. Urologists usually correct hypospadias when the child is between 6 and 12 months old because it is easier to take care of the surgery site.
New and better surgical techniques and procedures have been developed that allow the operation to be conducted at an earlier age. This helps prevent many of the psychological problems that children with hypospadias can have.
The goals of surgery are to correct curvature of the penis and to place the opening of the urethra in the correct location. Babies with hypospadias should not be circumcised, as the extra skin from the foreskin may be useful in helping the surgeon increase the length of or reconstruct the urethra.
Surgery is done while the baby is under general anesthesia. The baby may need more than one surgery if the urologist wants to straighten the penis before correcting the urethra; however, it is usually corrected in one procedure. The baby usually goes home the same day of the surgery.
Once surgery is completed, the baby may have a small catheter (tube) in order to pass urine. The catheter will stay in place for anywhere from a few days to two weeks. The doctor will also prescribe antibiotics to reduce the risk of any infection, as well as pain medications to help with any discomfort.
With modern technologies and techniques, hypospadias and chordee repair procedures are highly successful.
How do I care for my son after surgery?
The medical staff will give you information on how to care for your son while he is recovering, including instructions on bathing, tending to his bandage, and recognizing signs of infection or other complications.
As with any surgery, there is always the risk of infection or injury to the surgery site. It is important to follow the take-home instructions and closely watch your son’s recovery and the surgery site.
The surgery site will begin recovering immediately, though the full healing process may take several months. Bruising and swelling are common after the surgery, and should go away in the first few weeks of recovery.
Do not let your son play on toys that require him to straddle, such as riding toys or walkers, until the doctor has given his or her approval. It may also help with your son’s comfort to use double diapers to provide extra cushion.
Most recoveries continue without complications; however, call your child’s pediatrician immediately if you notice that your son has any of the following symptoms:
- a fever of 102 degrees or higher for more than 24 hours;
- unable to urinate, or difficulty urinating;
- a blue or gray discoloration at the tip of his penis:
- pain medication does not seem to be helping;
- bleeding from the surgery site.
Please note that it is normal for urine to appear pink for the first few days after surgery.
What is the outlook for boys born with hypospadias?
Most repairs of hypospadias last a lifetime and lead to normal, healthy function of the penis. Your son’s urologist will decide how frequently he should have follow-up appointments. Complications after the surgery are not common, but they do occur.
Occasionally, a hole known as a fistula will form from the urinary tract to the skin of the penis. There may also be scarring that can affect the flow of urine. If, after your son has recovered from his surgery, you notice that he is leaking urine or the urine stream is slow or weak, contact his doctor.
- Centers for Disease Control and Prevention. Facts About Hypospadias. www.cdc.gov Accessed 11/21/2012.
- UpToDate. Hypospadias. www.uptodate.com Accessed 11/21/2012.
- American Urological Association Foundation. Hypospadias. www.urologyhealth.org Accessed 11/21/2012.
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