15060 Hypospadias

Overview

Hypospadias is a condition a baby boy is born with, where the opening of the tube that carries urine out of the body (the urethra) is not at the tip of the penis. Instead, it is on the underside of the penis. This can affect the way urine comes out and the appearance of the penis.

Yes, it is fairly common. Around 1 in 200 to 300 newborn boys has hypospadias.

It only affects boys. It is usually noticed at birth or shortly after, when a doctor examines the baby.

Symptoms

Common symptoms

• The opening of the penis is lower than the tip, on the underside.
• The foreskin may not fully cover the tip, forming a hood-like shape on top.
• Urine stream may spray or point downward when urinating.
• The penis may curve downward when erect (this is called chordee).

Symptoms in children

• Same as above; you may notice your child struggles to aim urine when standing.
• The penis may look different from what you expect, which is usually the first sign.

Symptoms in older adults

• If hypospadias was not treated in childhood, an adult may notice urine spraying, difficulty with sexual intercourse, or feelings of embarrassment about the penis.

Causes

Main causes

• The exact cause is not known. It happens when the urethra does not develop fully in the womb.
• Hormones and genes are likely involved.

Risk factors

• A family history of hypospadias.
• Low birth weight or being born before 37 weeks (premature).
• Some fertility treatments or certain medicines taken during pregnancy (talk to your doctor if you have concerns).

When to see a doctor

See a doctor urgently if:

• If a newborn has not passed urine within the first 24 hours.
• If your child is straining or crying when trying to urinate.

Book a routine appointment if:

• If you notice the opening of the penis is not at the tip, or the foreskin looks unusual, make a routine appointment with your GP or pediatrician.
• If you have any concerns about your child’s penis, it is always okay to ask a doctor.

Diagnosis

A doctor can usually diagnose hypospadias by looking at the penis during a newborn physical exam. Sometimes they may watch the baby pass urine.

Tests that may be done

• No tests are needed for the diagnosis itself.
• If hypospadias is severe or there are other concerns, a doctor may recommend an ultrasound of the kidneys or a genetic test.

What to expect at your appointment

The doctor will explain exactly where the opening is and whether it affects the function of the penis. You will then be referred to a specialist doctor called a pediatric urologist, who can discuss treatment options and what to expect from surgery.

Treatment

Treatment depends on the position of the opening and whether there is any curvature. Most boys will need a relatively simple operation to straighten the penis if needed and to move the opening to the tip.

Self-care at home

• Before surgery, keep the area clean with gentle water and dry it well.
• After surgery, follow your surgeon’s instructions for dressing changes and bathing.
• Do not try to pull the foreskin back if it is incomplete or has not been operated on.

Medical treatments

No medication can correct hypospadias. If surgery is planned, the surgeon may give your child antibiotics just before or after the operation to reduce the risk of infection. Pain relief may be provided for a short time after surgery.

When is surgery considered?

Surgery is usually recommended between 6 and 18 months of age, before the child learns to use the toilet. It can also be done later. The operation is often a day-case procedure, meaning your child goes home the same day.

Living with this condition

Before surgery, hypospadias usually does not cause any pain or health problems. You can use nappies (diapers) as normal. After surgery, your child may have some swelling and a dressing, but he will feel better within a few days.

Lifestyle tips

• Allow your child to play and explore normally before surgery.
• After surgery, avoid activities that could put pressure on the penis until the surgeon says it is safe.
• When your child is older, teach him that it is normal to talk to his doctor about any concerns.

Diet and exercise

There are no special diet or exercise needs. After surgery, offer plenty of fluids to keep urine dilute and prevent constipation, which can strain the healing area.

Mental health and emotional wellbeing

Some boys and men may feel self-conscious about the appearance of their penis. Open conversations and reassurance from parents can help. If you or your child feel anxious, talking to a counselor or psychologist can provide extra support.

Prevention

No. Hypospadias develops in the womb and cannot be prevented.

Complications

If left untreated

• The urine stream may spray or point downward, which can make using the toilet awkward.
• In adulthood, curvature of the penis can make sexual intercourse difficult.
• Some men may feel embarrassed or anxious about the appearance of their penis.

Long-term outlook

With today’s surgical techniques, the outlook is very good. More than 90 out of 100 boys who have surgery have a penis that looks and functions normally. Even without surgery, hypospadias is not life-threatening, but surgery greatly improves quality of life.

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