What is hypospadias?
Hypospadias is a birth defect where the urethra doesn’t develop properly in a baby’s penis. The urethra is the tube that carries urine and sperm through the penis to exit the body.
Treatment prevents problems later in life, such as having to sit to pee or difficulties having sex.
How does hypospadias affect the penis?
Early in a baby’s development, the urethra starts as an open channel. The tube closes as a baby develops before birth. The urethra's opening — where sperm and urine exit — is called the meatus (me-ATE-us). Typically, the meatus is at the tip of the penis.
In a baby with hypospadias, the meatus forms in a different location. It might be on the shaft of the penis or the scrotum instead of on the penis’s tip.
What are the types of hypospadias?
Healthcare providers describe the type by where the urethra opens:
- Subcoronal: Near the head of the penis.
- Midshaft: Along the penis shaft.
- Penoscrotal: Where the penis and scrotum meet.
Is hypospadias the same as a curved penis (chordee)?
They are not the same condition. But babies with hypospadias can sometimes have a curved penis, called chordee or congenital penile curvature.
How common is hypospadias?
Hypospadias is common. It affects approximately one of every 250 to 300 newborn males. The rate seems to be rising in Western cultures — possibly because of the increased use of pollutants and pesticides.
Symptoms and Causes
What causes hypospadias?
Researchers don’t know exactly what causes hypospadias. However, it does seem to run in the family. Children with hypospadias are slightly more likely to have fathers and brothers who also have it.
The problem occurs during pregnancy. The penis begins to develop at around the eighth week of pregnancy. The urethra defect happens between weeks nine and 12.
Certain factors in the mother can increase the risk of the baby having hypospadias, including moms who:
- Carry extra weight (obesity).
- Are over age 35.
- Use fertility treatment to get pregnant (possibly because of exposure to progesterone, a hormone used during fertilization).
- Use other hormones before or during pregnancy.
- Have exposure to pesticides.
What are the symptoms of hypospadias?
In children with hypospadias, symptoms include:
- Chordee: Penis curves downward.
- Undescended testicle: One of the testicles doesn’t fully descend into the scrotum (in about 10% of cases)
- Undeveloped foreskin: The skin that covers the head of the penis isn’t complete. Babies with hypospadias should not be circumcised.
- Abnormal urination: Urine doesn’t spray in a straight stream.
Diagnosis and Tests
How is hypospadias diagnosed?
Healthcare providers usually diagnose this condition when a baby is born. Checking for hypospadias is part of the routine newborn examination after birth.
It’s easy to notice the problem: The hole of the penis is in the wrong place. Often, the foreskin is unformed, so the tip of the penis is exposed.
If the pediatrician detects hypospadias, they’ll refer you to a pediatric urologist for treatment. Hypospadias repair can correct the problem.
Management and Treatment
How is hypospadias treated?
Surgery can correct hypospadias. With newer surgical methods, children can have corrective surgery at an earlier age. Your healthcare provider will discuss the exact timing of your child’s surgery.
Many pediatric urologists do the surgery when your child is between six and 12 months old . At that age, it’s easier to care for the surgery site after the operation. It’s also safer for your child to have anesthesia.
What is the goal of hypospadias surgery?
The goal of hypospadias repair is a straight penis with a urethra in the right spot, at the penis tip. Babies with hypospadias should not be circumcised. The surgeon may use extra skin from the uncircumcised foreskin to do the repair.
During the surgery, the urologist:
- Straightens the penis shaft.
- Builds a new urethra.
- Positions the urethral opening at the tip of the penis.
- Reconstructs the foreskin.
What should I expect during my baby's surgery?
Your baby will be under general anesthesia during the surgery. They will be asleep and not feel any pain. Occasionally, the baby needs two surgeries: one to straighten the penis and one to fix the urethra. But often, the surgeon does it in one procedure. You can usually take your child home on the day of the surgery.
What happens after hypospadias surgery?
The baby may need a small tube called a catheter to pee. Usually, the catheter stays in for a few days or up to two weeks. Your healthcare provider will prescribe antibiotics to reduce the risk of infection. Pain medication can relieve discomfort.
How do I care for my baby after surgery?
You will get instructions about how to care for your baby during recovery, including how to:
- Bathe your baby.
- Tend to the bandage.
- Recognize signs of infections or complications.
Follow the instructions closely, and keep an eye on your baby’s recovery and the surgery site. The full healing process takes a few months. You may notice bruising and swelling, but that will go away in the first few weeks.
Can adults have hypospadias surgery?
Yes. Surgery can correct hypospadias in children of any age and in adults.
Can I prevent hypospadias?
Pregnant people can reduce the risk of their baby having hypospadias by practicing a healthy lifestyle:
- Don’t smoke or drink alcohol.
- Maintain a healthy weight.
- Take folic acid (around 400 to 800 micrograms a day) while pregnant.
- See your healthcare provider for regular checkups while pregnant.
Outlook / Prognosis
What is the outlook for children with hypospadias?
Hypospadias (and chordee) repair procedures are very successful. Most repairs last a lifetime. The penis has a normal, healthy function. Your child’s healthcare provider will discuss the schedule of any needed follow-up appointments.
Are there complications from hypospadias surgery?
Sometimes, a hole called a fistula can form from the urinary tract to the penis skin. And some babies have some scarring that can affect urine flow. If you notice your child leaking urine or having a weak, slow urine stream after surgery, contact your healthcare provider.
How can I best take care of my baby?
If your child had hypospadias surgery, don’t let them play on toys that require straddling, such as riding toys or walkers, until your healthcare provider gives the all-clear. You may also want to use double diapers to provide extra cushion.
When should I see my healthcare provider?
Your baby will likely recover fine without any complications. The urine might appear pink for a few days after surgery. But call your provider right away if you notice:
- Fever of 102° F or higher for more than 24 hours.
- Difficulty peeing or inability to pee.
- Blue or gray discoloration at the tip of the penis.
- Discomfort despite pain medication.
- Bleeding from surgical site.
A note from Cleveland Clinic
Hypospadias is a condition that affects babies at birth, causing the hole of the urethra to be located somewhere other than the tip of the penis. Hypospadias can cause problems with urination and sexual function if untreated. But hypospadias treatment is very effective. Surgery straightens the penis and places the hole in the right location. And usually hypospadias repair lasts a lifetime.