HYPOSPADIAS

Definition: When the opening normally at the end of the penis is located on the undersurface of the penis.

1. What caused this condition to occur?

There are multiple possible causes with genetic, environmental, and hormonal factors influencing development of the penis. No one is certain as to the exact cause of this condition. The incidence of hypospadias has been increasing worldwide over the past few decades. The incidence is approaching 1 percent of newborns.

2. What tests need to be done to further define the condition?

Typically, the diagnosis is made on physical examination of the newborn. The majority of boys with hypospadias will need no further evaluation to help plan a treatment course. If your child has an undescended testicle along with hypospadias, blood testing to evaluate for an endocrine problem or other developmental conditions should be performed. Some cases of severe hypospadias may also require such testing. It is not recommended to perform newborn circumcision in patients with hypospadias as the foreskin may be useful in reconstruction at a later date.

3. What kind of symptoms or problems can occur as a result of the condition?

The penis has basically two functions: urination and sex. Children with uncorrected hypospadias may be impacted in either or both of these categories. Penile curvature (chordee) associated with hypospadias may make penetration painful or difficult to achieve. Depending on the location of the urethral opening, urinating while standing may be impossible to perform without significant spraying and deflection of the urine stream. If the hypospadia is corrected, there should be no future problems in either area.

4. Will it need to be corrected? If so, when and how?

Almost all cases of hypospadias require surgical treatment, although some of the most minor hypospadias may not require any intervention. Many pediatric urologists will recommend surgery to be performed after four months of age. There are over two hundred described techniques that are used for hypospadia repairs. Your physician will discuss the technique that will be best suited for your son’s particular anatomy. There has been much advancement in technique over the past years, and now hypospadia repair is almost always done as a day surgery on an outpatient basis.

5. Do we need to see a urologist and, if so, when?

The timing of urologic consultation is up to you and your pediatrician. Hospital consultation may be warranted if there are concerns or uncertainty about the diagnosis. Otherwise, outpatient consultation is completely appropriate and can be performed anytime between zero and two months of age.

6. Is there a possibility that there will be a problem later on in sexual or urinary function?

As discussed above in question #3, there can be impact on both sexual or urinary function in patients with hypospadias. If the problem is corrected early in life, it is unlikely that there will be any future issues in either of these areas.

7. When do you wish to see my child again for this condition?

After the initial consultation with your urologist, either scheduling for correction or a follow-up visit for your child at around two months of age may be recommended. This will be influenced by the degree of hypospadias and any other medical issues that your child may have.