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What is hypospadias?

Hypospadias is one of the more common birth abnormalities of the genitalia in male infants, but most families are unaware of it as the condition is rarely discussed. In a normal penis, the urine tube (urethra) travels through the shaft of the penis to an opening (meatus) in the center of the head of the penis (glans). In males with hypospadias, the urine tube is short and does not come out to the end of the penis. The opening could be located anywhere along the underside of the shaft of the penis or even in the scrotum. In addition, the foreskin—loose skin surrounding the head of the penis removed during circumcision—is incompletely formed and there may be a bend in the penis called a chordee. Most children with hypospadias have no other abnormalities, though inguinal hernias and undescended testes are more common in children with hypospadias than in the general population.

How is hypospadias diagnosed?

Hypospadias develops during pregnancy and its cause is unknown. This condition is usually identified during the baby's initial physical examination. The first clue is often abnormal foreskin. However, there are some cases of hypospadias in which the foreskin is normal and doctors do not diagnose the condition until the foreskin is retracted or the male has been circumcised. Fortunately, almost 90 percent of hypospadias cases are minor with the urethral opening on or just below the head of the penis. In the remaining cases, there is likely to be some degree of functional difficulty with voiding and sexual activity.

What is the treatment for hypospadias?

Males with hypospadias should have surgery to ensure the opening (meatus) is far enough out on the shaft for them to urinate while standing and to ensure insemination (fertilization). The penis must be straight with erection for penetration during intercourse and also cosmetically acceptable. Most surgeons recommend surgery when the child is between 6 and 12 months old.

Hypospadias repairs are outpatient procedures and usually successful, especially when performed by an experienced surgeon. During the operation, our surgeon will correct the chordee (the bend) and create a new urethra extending to the tip of the penis, a covering for the new urethra, and an opening (meatus) at the tip of the penis. In many patients, surgeons correct the problem in a single operation, but no single repair method suffices for all patients.

In hypospadias, the child should not be circumcised before repair as the foreskin tissue is often essential for the surgical procedure.