Hypospadias is a condition in which the urethra is does not develop completely. This results in an opening that is somewhere on the underside of the penis, scrotum, or perineum. Hypospadias is almost always associated with other defects, including penile curvature (chordee) and an incomplete or hooded foreskin.
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What Is Hypospadias?
Hypospadias is a condition that results in a malformed or misplaced opening of the urethra in the penis. This abnormality occurs while the baby is developing during the window of weeks eight to 14 in pregnancy. The effect of hypospadias is an opening in any place along the urethra instead of at the tip of the penis.
This condition can have make it harder to urinate, and include a curved penis or an undescended testicle. Children with very mild hypospadias may have a few functional issues, but the condition can affect a child's ability to urinate while standing and eventually to have erections satisfactory for intercourse.
It is for these reasons, as well as the obvious cosmetic defect, that most parents elect to have hypospadias repaired.
What are the types of hypospadias?
The different types of hypospadias are based on the location of the opening of the urethra.
Distal hypospadias
When the opening of the urethra is in the penis, but lower than it should be.
It includes:
- Coronal — The opening is at the bottom of the head of the penis.
- Glanular —The opening is lower than it should be but still on the head of the penis.
- Subcoronal — The opening is located somewhere near the head of the penis.
Midshaft hypospadias
When the opening is located along the shaft of the penis, close to the middle of the shaft.
It includes:
- Penoscrotal — The opening is located where the penis and scrotum meet.
- Perineal — The opening is located in the area behind the scrotum and in front of the anus.
- Proximal shaft — The opening is located low on the shaft, but not yet at the level of the scrotum.
- Scrotal — The opening is located anywhere on the front or bottom of the scrotum.
How common is hypospadias?
Hypospadias is a common condition and is estimated to affect about 1 in every 150 boys born in the U.S.
What causes hypospadias?
The exact causes of hypospadias are unknown, although some factors believed to be involved include:
- Certain hormones during pregnancy.
- Family history.
- Fertility treatments.
- Mother's age and weight.
Hypospadias risk factors
The direct cause of hypospadias is still unknown, but the common factors are related to conditions of the pregnancy.
The chances your child will be born with hypospadias are heightened if:
- Conception was through the use of assisted reproductive technology.
- Mother’s age is over 30.
- Mother’s BMI is considered overweight or obese.
Complications of hypospadias
Left undiagnosed or untreated, some cases of hypospadias will not cause many issues. However, more severe cases of hypospadias can impair the ability to urinate and/or achieve and maintain an erection. This condition also comes with a cosmetic effect of the penis looking hooded or shrouded, which can be embarrassing.
What Are the Signs and Symptoms of Hypospadias?
Some boys with mild forms of hypospadias have no symptoms at all.
Symptoms may include:
- Abnormal or downward-pointed urine stream.
- Downward curve of the penis (chordee).
- Hooded appearance of the penis.
- Opening of the urethra is at a location other than the tip of the penis.
When should I see a doctor about my hypospadias symptoms?
This condition should be caught at birth. Determining the right course of action may take some consultation with your doctor and time waiting to see how your child’s hypospadias affects them.
The main solution is a surgical correction, so you would need to meet with a specialist surgeon, as well as your primary care physician. Surgical procedures for hypospadias usually occur between the ages of 3 months to 18 months.
How Do You Diagnose Hypospadias?
Hypospadias is generally diagnosed with a physical exam when a baby is born. Most hypospadias will be easily recognized due to the appearance of the penis and foreskin.
Circumcision is generally not recommended when hypospadias is known, as the surgeon may need to use the foreskin tissue as part of hypospadias repair surgery. Occasionally, hypospadias is recognized after circumcision; these are usually the most minor forms.
Your pediatrician will determine if a urology referral is necessary. Some boys with mild hypospadias may note more penile curvature after puberty, which warrants evaluation by a urologist.
How Do You Treat Hypospadias?
Repair of hypospadias can take many forms, depending on the severity of the deformity.
The first step of any repair is straightening the penis. Almost all hypospadiac penises will have some degree of curvature that needs to be corrected. Often this can be accomplished simply by "degloving" the penis. Degloving involves making an incision around the skin of the penis just under the coronal groove.
As the skin is separated from the shaft of the penis, tethering bands of tissue are released, straightening the penis. Sometimes this dissection can be carried under the skin of the scrotum and even into the perineum, referred to as a radical mobilization of the urethra, a technique developed by UPMC pediatric urology specialists.
If degloving the penis does not result in sufficient straightening, further treatment will be needed. These treatment options fall into two general categories:
- Procedures that create tucks on the top side of the penis to correct the disproportion between the top and bottom sides. This is generally done for relatively mild curvature.
- Opening the lining of the erectile part of the penis on its underside, and inserting a graft material, most commonly from skin of the abdominal wall.
What happens during hypospadias treatment?
A penis with severe curvature that requires grafting on the underside will often be repaired in a staged fashion. The first operation involves straightening the penis as described and transposing most of the foreskin to the underside of the penis for later use in reconstructing the urethra. Approximately six months later, a second operation is performed to create a urethra from the skin on the underside of the penis.
If the urethral plate can be preserved, most often UPMC specialists will try to use it as a primary repair for the hypospadias. This results in a urethra that is composed completely of tissue that was originally intended to be urethra, rather than using skin or other materials. This technique also gives a very normal functional and cosmetic result.
Repair of severe hypospadias or repair after prior failed surgery might require a "free graft" of tissue to rebuild the urethra. This graft can be skin from the penis, inner arm, or lining of the mouth.
Hospitalization is often required after a free graft repair to allow the graft to heal in place with as little movement of the area as possible.
How effective is treatment?
Overall, the results of hypospadias repair are excellent. However, it is important to realize that no surgical procedure is perfect and that the results of hypospadias repair cannot be guaranteed.
Nevertheless, in almost every case, these problems can be dealt with to give a very acceptable result.
How long does it take to recover after hypospadias surgery?
Surgery for hypospadias will come in two phases, each with some recovery and rest necessary after the surgery. This surgery is often performed within the first two years of life, so there is usually little impact on the child's daily routine. Recovery can take a few weeks to allow the surgery to heal and for the stent that will be placed to be removed later.
