What Is Hypospadias?
Hypospadias is a congenital difference in urinary tract development seen in boys. Normally, the urinary opening (the meatus) should be located at the tip of the penis; in hypospadias, it instead sits somewhere along the underside of the penis, further back from the tip. It can range from mild to more severe depending on where the opening is located. It's one of the more common congenital conditions seen in pediatric urology, and can occur on its own or alongside other findings.
Why Does It Happen?
Hypospadias results from incomplete fusion of the urethra during a baby's development in the womb. The exact cause isn't always known; genetic predisposition and developmental factors are thought to play a role. Having a similar family history may slightly increase the likelihood. What matters most is that it is not caused by anything the parents did.
What Are the Signs?
The most obvious sign is the unusual position of the urinary opening. In addition, downward curvature of the penis (chordee), a foreskin that's incomplete at the front and excess at the back (giving a hooded appearance), and a change in the direction of the urine stream can also occur. Most cases are noticed at birth or shortly after.
Why Shouldn't Circumcision Be Performed?
When hypospadias is identified, it's important that the baby not undergo standard circumcision. That's because the foreskin is valuable tissue that may be needed during the repair surgery. For this reason, circumcision should not be scheduled without first consulting a pediatric urologist.
Evaluation and Diagnosis
Diagnosis is usually made through a physical exam; additional imaging is often not necessary. In more severe cases or when other findings are present, the physician may recommend further evaluation. The assessment takes into account the position of the opening, the degree of curvature, and the condition of the tissues.
Treatment and Surgical Timing
Hypospadias is treated surgically, with the goal of achieving a good outcome both functionally (a straight urine stream, normal sexual function later in life) and cosmetically. Current pediatric urology guidelines generally recommend that, in suitable cases, repair be performed between roughly 6 and 18 months of age — a period favored both for healing and because the child is less affected by the process. That said, hypospadias can be corrected at any age, and the treatment decision is planned individually for each child. The surgical approach depends on the type of hypospadias, and some more complex cases may require more than one stage.
Recovery
A urinary catheter or stent may be used for a short period after surgery, along with wound care. Most children recover comfortably. Long-term follow-up is important for assessing the outcome.
Frequently Asked Questions
Does hypospadias correct itself?
No, it does not resolve on its own; treatment is surgical.
Will my child be able to have children later in life?
In mild, isolated cases reproductive function is usually unaffected; however, this should be assessed with a physician based on the specifics of the case.
Have we missed the window for surgery?
While early repair is preferred, correction can still be performed at older ages. The best course of action is to consult a specialist for evaluation.