Hypospadias

What is hypospadias?

Hypospadias is a condition where the urethra and foreskin don’t develop properly in a baby’s penis. The urethra is the tube that carries pee (urine) and semen (ejaculate) through the penis and outside of the body. The foreskin is the skin that normally covers the head of the penis completely in uncircumcised people.

Early in a fetus’s development, the urethra starts as an open channel. The channel closes to form a complete tube as a fetus develops before birth. The meatus is the opening at the end of the urethra. It’s usually in the head of or at the tip of the penis. It’s where semen and pee exit the body.

In a baby with hypospadias, the urethral tube doesn’t close all the way, causing the meatus to form below the tip of the penis. It may exist anywhere along the shaft of the penis, in the scrotum or even lower, near the butthole (anus). The scrotum is the pouch of skin behind the penis that usually holds the testicles. The anus is where poop exits the body.

Hypospadias is a congenital condition, which means it’s present at birth. It can range from mild to severe. Without treatment, problems can develop later in life, including difficulty peeing and difficulties having sexual intercourse.

Is hypospadias a serious problem?

Hypospadias can range from very mild to severe. A surgeon may not need to repair mild cases. But in most cases, hypospadias requires surgery.

What are the types of hypospadias?

Healthcare provides categorize the type of hypospadias by where the urethra opens:

• Glanular (balanic). Glanular hypospadias is when the meatus or urethral opening is in the head of the penis, but not all the way at the tip. It’s the mildest type of hypospadias.
• Coronal. Coronal hypospadias is the most common form of hypospadias. It’s when the meatus is just below the head of the penis or where the head of the penis meets the shaft.
• Midshaft. Midshaft hypospadias occurs halfway down the penis shaft.
• Penoscrotal. Penoscrotal hypospadias occurs where the penis and scrotum meet.
• Scrotal/Perineal. Scrotal and perineal hypospadias are the most severe forms of hypospadias. The urethra opens on or below the scrotum.

How common is hypospadias?

Hypospadias is common. It occurs in approximately 1 of every 150 to 300 children assigned male at birth (AMAB). It’s the second-most common congenital condition that affects children AMAB, behind undescended testicles. The milder forms happen more often than the severe forms.

The rate of hypospadias seems to be increasing in Western cultures. Researchers suspect there may be a link between rising rates of hypospadias and the increased use of certain chemicals, pollutants and pesticides.

What are the symptoms of hypospadias?

The main symptom of hypospadias is that the meatus isn’t at the tip of the penis. Other hypospadias symptoms may include:

• Problems peeing. Pee doesn’t spray in a straight stream. It may spray to the sides or down. Peeing may also irritate tissue in the surrounding area and cause discomfort.
• Underdeveloped foreskin. The foreskin only covers part of the penis. Don’t circumcise your child if they have an underdeveloped foreskin. A healthcare provider may use a small piece of the underdeveloped foreskin during surgical treatment.
• Chordee (congenital curved penis). The penis curves downward.
• Undescended testicles. One or both testicles don’t descend into the scrotum.

Is hypospadias the same as a chordee?

No, hypospadias and a chordee aren’t the same condition. But babies with hypospadias can sometimes have a chordee.

What causes hypospadias?

Healthcare providers and medical researchers don’t know exactly what causes hypospadias. Certain chemicals may increase the risk of hypospadias. There may also be a genetic link. A baby is more likely to have hypospadias if they have a biological relative AMAB (father or brother) who also had hypospadias.

Hypospadias can happen in babies AMAB without any other medical problem. But providers often see it with other birth defects and congenital problems.

Hypospadias occurs during early pregnancy. The penis starts to develop around the eighth week of pregnancy. Hypospadias occurs between weeks nine and 12.

Who does hypospadias affect?

Certain factors in the birthing parent (mother) may increase the risk of a baby having hypospadias. These include:

• A body mass index (BMI) greater than 30 (has obesity).
• A birthing parent who’s older than 35 while pregnant (advanced maternal age).
• Using fertility treatment to get pregnant. This may be because of the use of progesterone. Progesterone is a hormone healthcare providers use during fertility treatments to support the early stages of pregnancy.
• Using other hormones before or during pregnancy.
• Chemical or pesticide exposure.
• Smoking while pregnant.

Can I have a baby if I have hypospadias?

You may have difficulty getting pregnant with a partner through sexual intercourse if you have a more severe form of hypospadias or have a very bent penis due to hypospadias. Without treatment, hypospadias can create problems with the penis being able to enter the vagina and semen reaching the inside of the vagina. This can affect your ability to have biological children through sex and could result in male infertility.

Can you pee with hypospadias?

You can pee with hypospadias, but it may be difficult to stand and pee. You may need to sit down so you don’t spray pee outside of the toilet.

How is hypospadias diagnosed?

Hypospadias is usually easy to diagnose because the meatus isn’t at the tip of the penis. Often, the foreskin doesn’t fully form or cover the underside of the penis as it normally should. Sometimes, the abnormal foreskin looks like a “hood” on the back of the penis. The penis may have a downward curve or bend. In more severe forms, the penis may be very small or short, and the scrotum may look like it’s separated into two halves.

Healthcare providers usually diagnose hypospadias shortly after birth. Checking for hypospadias is part of the routine newborn physical examination that a pediatrician performs. Sometimes, providers don’t catch hypospadias until they circumcise the baby. If your healthcare provider diagnoses hypospadias, they won’t continue the circumcision.

What type of doctor treats hypospadias?

If a pediatrician detects hypospadias, they’ll refer you to a pediatric urologist. A pediatric urologist is a doctor who specializes in diagnosing and treating conditions that affect the urinary and reproductive systems in children.

How is hypospadias treated?

Surgery (hypospadias repair) can treat hypospadias. Most pediatric urologists will perform a hypospadias repair when your child is between 6 and 12 months old. At that age, it’s easy to care for the surgery site after the procedure. It’s also safer for your child to have general anesthesia.

Surgery is usually an outpatient procedure (meaning your baby will go home the same day) and may take several hours to perform. Sometimes, healthcare providers must treat hypospadias in separate stages, especially if the hypospadias is more severe.

During hypospadias repair, the pediatric urologist will:

• Straighten the penis and correct any curvature.
• Reconstruct the urethra to complete the “tube.” This will create a urethral opening near the tip of the penis.
• Reconstruct the remaining penis skin and perform a circumcision.
• Sometimes, a provider will insert a temporary Foley catheter and leave it in place while the urethra and penis heal. A provider will remove the catheter at a follow-up appointment, usually one to two weeks after the surgery.

What are the complications or side effects of hypospadias repair?

All types of surgery come with some risks, including:

• Anesthesia risks.
• Infection.
• Bleeding.
• Scarring or abnormal healing.

Specific hypospadias repair risks include:

• Urethrocutaneous fistula. A urethrocutaneous fistula is a hole that forms between the urethra and the outer skin of the penis. This causes pee to exit the body at the wrong location.
• Urethral stricture. A urethral stricture is when scarring causes the urethra to narrow. It can happen at the new meatus or anywhere in the repaired urethra. This can make it difficult to pee and create pressure on the bladder, kidneys, prostate and testicles. It can also lead to a pee stream that sprays or shoots in an abnormal direction.
• Urethral diverticulum. A urethral diverticulum is when the urethra widens (dilates) and stretches out near the area of the repair. Pee may gather in the stretched-out part, causing dribbling and/or urinary tract infections (UTIs).
• Recurrent curvature. Sometimes after a hypospadias repair, the penis may curve again over time.

How soon after treatment will my child feel better?

Recovery times may vary. Most children make a full recovery about six to eight weeks after a hypospadias repair. A healthcare provider will give you prescription medications to treat pain and prevent infection after surgery.

Can hypospadias be prevented?

Pregnant people can reduce their babies’s risk of having hypospadias by:

• Not smoking or drinking alcohol.
• Maintaining a healthy weight for them.
• Taking folic acid (around 400 to 800 micrograms a day).
• Seeing a healthcare provider for regular checkups.

What can I expect if I my child has hypospadias?

The outlook for hypospadias is good. Hypospadias repair has a high success rate. The goal of successful surgery is to create a penis that appears and functions normally.

How do I take care of my baby with hypospadias?

Before surgery, clean your baby’s penis normally during diaper changes and baths. There’s no need to forcefully pull back the foreskin or use any specific cleaning products.

After a hypospadias repair, follow your surgeon’s instructions. Keep your child’s affected areas as clean as possible to help prevent an infection. Wash your hands with soap and water before changing your child’s diaper or handling the area. If pee or poop gets on the area, gently clean the area with warm, soapy water and pat the area dry.

You should be able to sponge-bathe your child after a hypospadias repair. Carefully wash the area with soap and warm water. Pat the area dry with a towel. If your baby has a temporary catheter in place, ensure nothing pulls on it and that it drains appropriately. Once a provider removes the catheter, your baby can have regular baths again.

Your child should avoid lying on their stomach or playing on straddle toys, including a rocking horse, seesaw, swing, bicycle or jumper for two to three weeks.

Swelling, bruising and discoloration are very normal after hypospadias repair. They’ll gradually improve in one to two months.

When should I see a healthcare provider?

Schedule follow-up appointments as recommended with your child’s healthcare provider. They’ll want to make sure your child’s penis is healing properly. If your child has a severe hypospadias, you may need to schedule more operations.

When should I go to the ER?

Take your child to the nearest emergency room if they experience any of the following symptoms after a hypospadias repair:

• A fever of 102 degrees Fahrenheit (38.9 degrees Celsius) or higher.
• Difficulty peeing or an inability to pee.
• Discomfort or pain that doesn’t respond to medication. Your child may have high-pitched crying, struggle to calm down or not take a pacifier or feed.
• Excessive bleeding from the surgical site.

What questions should I ask a healthcare provider?

You may want to ask your child’s provider:

• How do you know my child has hypospadias?
• If my child doesn’t have hypospadias, what other condition might they have?
• What type of hypospadias does my child have?
• How severe is my child’s hypospadias?
• Does my child need a hypospadias repair?
• When should my child get a hypospadias repair?
• How often should I schedule follow-up appointments?

Does hypospadias mean intersex?

In most cases, there’s no association between hypospadias and any other conditions. But sometimes, there may be a link between hypospadias and intersex. People who are intersex have reproductive or sexual anatomy that doesn’t fit into the male or female sex binary.

Do you get hypospadias from mom or dad?

One study shows that children may inherit hypospadias equally between both biological parents.

What is the difference between hypospadias and epispadias?

Epispadias is also a congenital condition that affects the urethra. But the meatus forms at the top of the penis, not toward the bottom. Epispadias is a much rarer than hypospadias.

A note from Cleveland Clinic

Hypospadias is a condition that affects babies at birth. The hole at the end of the urethra forms somewhere other than the tip of the penis. A healthcare provider can’t complete a circumcision during the newborn stage for most babies who have hypospadias. Hypospadias may lead to problems with peeing, sexual function and fertility later in life. It can be scary to hear that your baby might need surgical treatment. But hypospadias repair has a high success rate and good long-term results. Talk to a healthcare provider to learn more about this condition and treatment options.