15991 Hypospadias Repair

Overview

Hypospadias is a difference in how a baby boy's penis forms before birth. The tube that carries urine out of the body (the urethra) opens on the underside of the penis instead of at the tip. The opening can be just below the tip, halfway down, or further back near the scrotum. The foreskin may also look uneven, with skin only on the top, and the penis may curve downward. Hypospadias repair is an operation that moves the opening to the tip of the penis and straightens it, so urine flows forward in the usual way.

Yes. Hypospadias is one of the most common birth differences seen in baby boys. Because it is common, surgeons and children's nurses are very experienced at treating it.

It affects babies born with a penis. It is found during the newborn physical examination, so it is almost always known about in the first days of life. It is not something that develops later in childhood or adult life.

Symptoms

Common symptoms

• The opening where urine comes out is on the underside of the penis rather than at the tip
• The foreskin looks uneven, with extra skin on top and little or none underneath (often called a hooded foreskin)
• The penis curves downward, which is most noticeable when it becomes firm
• Urine sprays in a scattered direction or dribbles rather than flowing straight
• A boy may need to sit down to pass urine, or may need to aim carefully
• The stream of urine may be thin or weak

Symptoms in children

• Spraying or dribbling urine, which can make toilet training harder
• Needing to sit to pass urine when other boys stand
• Wetting or damp patches on underwear after using the toilet
• Older boys may feel self-conscious about how the penis looks or about the direction of the urine stream

Symptoms in older adults

• Hypospadias is present from birth, so an adult with it has had it all their life
• Some men who were not treated as children notice spraying, a downward curve, or difficulty aiming the urine stream
• Some men have concerns about how the penis looks, about sex, or about fertility
• There may be worries or embarrassment that have built up over many years

Causes

Main causes

• Hypospadias happens while the penis is forming in the womb, when the tube that becomes the urethra does not close fully along the underside
• It is caused by a mix of genetic and environmental factors, and in most cases the exact reason is not known
• Hormones that guide development in the womb, such as testosterone, play a part in how the tube closes
• It is not caused by anything a parent did or did not do during pregnancy

Risk factors

• A family history of hypospadias, such as a father or brother who had it
• Being born early (premature) or with a low birth weight
• Conception with fertility treatments such as IVF, which is linked with a small increase in risk
• Some pregnancies where hormone signals in the womb are altered
• It is more common in some families and in certain population groups, though the reasons are not fully clear

When to see a doctor

See a doctor urgently if:

• Your newborn has not passed urine in the first 24 hours of life
• Your baby seems to be in pain and has a firm, swollen lower belly
• After surgery: fever, heavy bleeding, a wound that is opening, or a catheter that is not draining
• Your child cannot pass urine at all after surgery

Book a routine appointment if:

• You notice the urine opening is not at the tip of the penis, or the foreskin looks uneven
• Your son's urine stream sprays or dribbles, or he has to sit to pass urine
• The penis curves noticeably downward
• You have questions about whether or when surgery should be done
• You or your child feel worried or self-conscious about how things look or work

Diagnosis

Hypospadias is usually found during the routine newborn physical examination, simply by looking at the penis. The doctor checks where the opening is, how the foreskin looks, and whether the penis curves. Most boys do not need any tests. Sometimes the doctor will watch your baby pass urine, or ask about the stream. If the opening is far back or other features are present, the team may check the kidneys and bladder with a scan.

Tests that may be done

• A careful physical examination of the penis, foreskin, and scrotum
• Watching how your baby passes urine, and where the stream comes from
• An ultrasound scan of the kidneys and bladder in some cases, especially if the opening is far back
• Rarely, blood tests or genetic tests if other features suggest a wider condition
• In older boys or adults, a test that measures how fast urine flows

What to expect at your appointment

You will usually meet a children's surgeon or urology team at an outpatient clinic. They will explain the type of hypospadias, whether surgery is recommended, and what the operation involves. Bring a list of questions — it helps to write them down beforehand. You do not have to decide anything at the first visit.

Treatment

Surgery is the main treatment for hypospadias. The aim is to bring the urine opening to the tip of the penis, straighten any downward curve, and make the penis look as typical as possible. Not every boy needs an operation — very mild cases near the tip may be left alone after a discussion with the surgeon. Your care team will help you weigh the benefits and risks.

Self-care at home

• Keep the surgical area clean and follow your team's instructions about bathing and dressings
• If your child comes home with a catheter, a common trick is to put one nappy on normally and a second, larger nappy over it, with the tube fed through the outer nappy
• Encourage plenty of drinks to keep urine flowing and to help flush the area
• Dress your child in loose, soft clothing and avoid tight waistbands
• Avoid straddling toys, scooters and bikes for the advised number of weeks after surgery
• Give pain relief exactly as your care team advises, and never give more than the recommended amount
• Attend all follow-up appointments, even if everything looks fine

Medical treatments

No medicine can move the urine opening or straighten the penis — surgery is the only way to change the anatomy. Around the time of an operation, your care team may prescribe pain relief and, in some cases, antibiotics to reduce the risk of infection. They may also recommend a short course of medicine to calm bladder spasms while a catheter is in place. Always follow the instructions given by your own surgical team, and ask your pharmacist if you are unsure about anything.

When is surgery considered?

Repair is usually recommended between 6 and 18 months of age. This is a good time because the penis is small but the tissues heal well, and the child is not yet aware of the operation. Surgery can still be done later in childhood, in the teenage years, or in adulthood if it was not done earlier. In some cases, a surgeon may advise waiting or may advise that surgery is not needed at all. The decision is made together with your specialist team.

Living with this condition

Most of the time, hypospadias has little effect on daily life. After recovery from surgery, boys usually pass urine normally and take part in all the same activities as their friends. In the first few weeks after an operation, you will need to be a little more careful with nappies, baths and play, but this is temporary.

Lifestyle tips

• Encourage your child to drink regularly through the day, which keeps urine flowing well
• Teach good toilet habits, such as sitting or standing in a way that works for your child
• Let your child's school or nursery know about any operation and any temporary restrictions
• Treat any embarrassment gently and matter-of-factly — it is a common, fixable difference
• Keep up with follow-up appointments, which often continue until your child is toilet trained or older

Diet and exercise

No special diet is needed. A normal, balanced diet and plenty to drink are enough. After surgery, your team will tell you when your child can go back to running, swimming, bike riding and PE. Gentle walking and normal play are usually fine quite quickly. Always follow the advice of your own surgical team.

Mental health and emotional wellbeing

Finding out your baby needs an operation can bring up worry, guilt or sadness — these feelings are normal and do not mean you have done anything wrong. As children grow, some may feel self-conscious about how their penis looks or about standing to urinate. Most cope well, especially when parents answer questions calmly and honestly. If your child, teenager, or you as a parent feel low, anxious or overwhelmed, speak to your GP or your child's care team. For anyone in crisis or having thoughts of harming themselves, contact your local emergency number or a crisis support service in your country straight away.

Prevention

There is no proven way to prevent hypospadias. It happens very early in pregnancy, often before anyone knows they are pregnant, and it is not caused by anything a parent did. General healthy pregnancy advice still helps your baby's overall development — for example, taking folic acid, avoiding smoking and alcohol, and attending antenatal appointments.

Screening programmes

Hypospadias is not screened for during pregnancy. It is usually found during the routine newborn physical examination, which is done for all babies in the first few days of life.

Complications

If left untreated

• Urine spraying or dribbling, making it hard to aim and sometimes causing wet clothes
• A downward curve of the penis that may cause discomfort or difficulty during sex later in life
• If the opening is far back, semen may not be delivered at the tip, which can affect fertility
• A higher chance of urinary infections in some cases
• Embarrassment, low confidence, or distress about appearance and function

Long-term outlook

The outlook is generally very good. Most boys who have a repair pass urine in a normal forward stream, and the penis looks and works well. A small number — roughly 1 in 10 to 1 in 5, depending on how severe the hypospadias was — need a second operation for a small problem such as a narrowing or a leak. Your surgical team will keep an eye on this at follow-up. If you have any worries at any stage, ask — help is available.

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