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Pediatric Hypospadias

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Summary

Many boys are born with hypospadias, in which the urinary opening is not at the normal position at the tip of the penis. In this condition, the opening could be just a few millimeters away from where it usually is. In other cases, it could be located in the scrotum or even farther back in the body.

Expanded overview

This birth defect has physical consequences but also social ones for children who want to grow up both healthy and with strong self-esteem. Treatment is a surgical procedure best completed before your child is more than 18 months old.

Tests and Diagnosis

Hypospadias is a fairly common birth defect among boys. It is almost always diagnosed during a physical exam very shortly after birth.

Although the initial diagnosis is usually straightforward, your pediatrician is likely to suggest some imaging tests to determine if additional complications exist, or are likely to develop.

Symptoms

Typically, boys with hypospadias will have unusual spraying patterns when urinating. Some boys also have a curvature of the penis, or a testicle that has not descended properly into the scrotum.

Hypospadias is usually accompanied with other health issues. One is called chordee, which means the penis curves downward. Also, an infant’s foreskin is sometimes not complete when he has hypospadias. Other times, however, the foreskin is fine and hypospadias is only discovered after a circumcision.

As they grow, boys with this condition may not be able to urinate standing up. When the condition is not treated, hypospadias will likely cause problems with sexual function, such as difficulty having an erection or ejaculating.

Talk with your child’s doctor if you notice: 

  • The opening to the urethra, where urine exits the body, is not on the tip of the penis, is unusually large or oddly shaped.
  • An unusual shape or bend in the penis
  • Unusual urination pattern or apparent difficulty urinating

Diagnosis

Depending on the location of the opening of the urethra and other factors, including any curvature of the penis, your doctor may recommend some imaging to determine the extent of the condition. 

Treatment

In almost all cases, surgery is required to correct hypospadias and ensure that the penis can function properly. Surgical treatments vary depending on the size and location of the urethral opening and whether other complications are present.

If your child's pediatrician diagnoses hypospadias, they will likely refer you to a pediatric urologist to discuss treatment.

The size and location of the urethral opening will determine which surgical procedure is best for your child. Surgery can be performed on patients as young as three months old. Although surgical corrections can be performed on boys (or men) of almost any age, it is highly preferable to correct hypospadias before the boy reaches school age, and urologists recommend hypospadias surgery be completed before the boy is circumcised.

Technically, surgery isn’t necessary for all forms of hypospadias. Also, while it’s ideal to have surgery as an infant, hypospadias can be treated at any age.

However, if the condition is left uncorrected, boys will have complications urinating and potentially with fertility, as the delivery of sperm will be altered. In some cases, a boy will have problems maintaining an erection.

There are also significant social concerns as boys mature and interact with peers.

The medical staff at Children’s Health will discuss all options with families. Treatment will address three issues: moving the opening of the urethra to its normal place, removing any curve of the penis and improving the appearance of the penis. That way, not only are the physical issues associated with hypospadias addressed, but potential mental-health issues are addressed as well.

Prevention

In many cases, the cause of hypospadias is unknown, and therefore, it cannot be prevented. Studies have shown that mothers who are 35 or older or who are obese when they get pregnant are more likely to have sons with the condition, so establishing a healthy weight before pregnancy may reduce your chances of having a child with hypospadias.

The good news about hypospadias surgeries is that the majority of these defects can be corrected with one or two surgeries, and most males who are treated for the condition experience normal penis function, including during sexual activity, throughout their lives. 

FAQs

What are the signs or symptoms of hypospadias?

Hypospadias can be diagnosed in a simple physical exam. The urethral opening, which is normally located on the tip of the penis, is located lower or on the side of the penis. It may be larger, or misshapen. 

What causes hypospadias?

There’s still much to be learned about the causes of hypospadias, but it’s been determined:

  • Problems during the 9th and 20th weeks of pregnancy, when the urinary channel and foreskin are formed, can trigger hypospadias
  • Fathers and brothers of children with hypospadias are slightly more likely to have the abnormality. For example, if the father and a brother have hypospadias, there’s a 21 percent chance the next child could have hypospadias.
  • Children with mothers who are 35 years or older and obese have a higher risk of hypospadias.
  • Women who use fertility treatments or took certain hormones have a higher risk of having baby with hypospadias.

Are there different types of hypospadias?

There are different degrees of hypospadias:

  • Subcoronal hypospadias occurs when the location of the opening is near the head of the penis. About two-thirds of hypospadias fits this description.
  • Midshaft hypospadias is diagnosed when the opening is somewhere on the shaft of the penis.
  • Penoscrotal hypospadias describes the condition when the urethral opening is located where the penis and the scrotum meet.

How does hypospadias interfere with penis function?

The unusual location of the urethral opening interferes with urination. In some cases, a boy with the condition will not be able to urinate from a standing position. As a boy develops, hypospadias can affect erections and other sexual function.

How is hypospadias treated?

Generally, surgery is required, and most urologists recommend correcting the condition early in the boy’s life, as soon as three months old. In mild cases, a single surgical procedure can correct the condition.

If surgery is necessary, what can I expect?

Surgery is performed under general anesthesia. Sometimes, part of the foreskin is used to repair the urethral opening. A trained urological surgeon will perform the operation and explain how to care for the surgical site after the procedure.

What about after surgery?

Healing begins immediately, although some bruising and swelling will also be apparent at first. In many cases, a catheter is inserted in the penis following surgery to help with urination. It can drain into your son’s diaper or (in older boys) may be contained in a small bag that you can empty as needed. On follow-up visits, as healing continues, your doctor will discuss whether additional treatment may be needed. 

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