Hypospadias

Index

1. What is it?
2. Prognosis
3. Symptoms that cause hypospadias
4. Medical tests
5. Causes of hypospadias
6. Can it be prevented?
7. Treatment
8. What specialist treats it?

What is hypospadias?

Hypospadias is a relatively common congenital condition found in male infants, in which the opening of the urethra is not in its usual position at the end of the penis, but is located somewhere along the underside. The position of this opening (known as the urethral meatus) in hypospadias is most common at the junction of the head (glans) of the penis and the shaft, although it can be found anywhere along the underside of the shaft. In rare cases it may even be in or below the scrotum.

Prognosis

Most hypospadias surgeries last a lifetime and lead to normal, healthy penile function. Your child’s urologist will decide how often your child should have follow-up appointments. Complications after surgery are unusual, but can occur.

Symptoms of hypospadias

The main symptom of hypospadias is the fact that the urethral meatus is not at the tip of the penis. It is often accompanied by the following:

• Hock: a phenomenon whereby the penis curves downward.
• Hooded appearance of the penis, as only the upper half has foreskin to cover it.

Hypospadias can also cause problems with penile function:

• Abnormal spurting when urinating.
• The child may have to sit down to urinate when he is old enough to go to the bathroom.
• Problems with ejaculation and/or having children; it may be difficult to direct sperm into the uterus during intercourse.

Minor hypospadias does not require treatment.

Medical tests

Hypospadias can be diagnosed by clinical examination of the penis, its shape, and the site of the urinary opening (meatus). Generally, the diagnosis is made by the pediatrician during the physical examination of the healthy child or during the office examination. Imaging tests may be done to look for other congenital anomalies.

What are the causes of hypospadias?

Hypospadias is a congenital condition, which means it is present when the baby is born. During development in the womb, certain hormones control the development of the penis and the formation of the urethra and foreskin. It is believed that a malfunction of these hormones leads to hypospadias, but it is unclear what exactly causes this malfunction. Theories include:

• Genetics: hypospadias appears to be inherited.
• Mother’s age: the condition appears to be more common in babies born to mothers older than 35 years, making it a potential risk factor.
• Mother’s weight: Mothers classified as overweight have an increased risk of having a baby with hypospadias.
• Exposure to certain substances in utero: it is thought that if the developing baby is exposed, through the pregnant mother, to certain chemicals, tobacco, alcohol and even certain fertility drugs, this could increase the risk of hypospadias, but more studies are needed to confirm this.

Can hypospadias be prevented?

As it is a congenital pathology, prevention is very complicated. The only known preventive action is to avoid the intake of hormones, called “progestogens”, during the first 2 trimesters of pregnancy.

Treatments for hypospadias

Minor hypospadias, where the urethral opening is not far from its proper position, often do not require treatment. In other cases, surgery will be needed to reposition the urethral meatus, which may involve grafting tissue taken from the foreskin or from inside the mouth. In some cases, the shaft may also have to be surgically straightened. Surgery is usually performed around 9 months of age.

What type of specialist treats hypospadias?

Pediatric urologists are specialists in treating diseases of the penis in children, while pediatric surgeons may have to perform a procedure to correct hypospadias.