Hypospadias is a congenital condition that affects approximately 1 out of 200 boys. In this condition, the urethral opening (meatus) is found on the underside of the penis instead of the tip (glans).

Hypospadias is a common condition that does not entail much difficulty when it comes to infant care. The recommended treatment for the ailment is surgery. Hypospadias repair surgery restores the typical appearance of the penis and rectifies any impairments associated with urination and reproduction.

• Types of Hypospadias

Distal or glandular: Opening is found near the head of the penis; the most common variant of hypospadias

Midshaft: Opening is found in the middle or lower shaft of the penis

Penoscrotal: Opening is found at the meeting point of the penis and the scrotum

Perineal: Opening is located behind the scrotal sac; the least common and the most severe form of hypospadias

• Symptoms of Hypospadias

Signs and symptoms of hypospadias may include:

• Meatus or the opening of the urethra is found at a location other than the glans or the tip of the penis
• Downward curving of the penis, also referred to as chordee
• Spraying during urination
• The abnormal hooded appearance of the penis as only the top half of the penis is covered by the foreskin

• When you should see a doctor

Most infants with hypospadias are diagnosed with the condition soon after birth. Mild cases of hypospadias, i.e., those with a slight displacement of the urethral opening, may be more challenging to identify. 

Consult your child’s doctor if you have any concerns regarding the appearance of the penis or if you encounter any problems with urination.

• Causes of Hypospadias

The formation of the male reproductive system is monitored by certain hormones that stimulate the formation of the urethra and the penile foreskin. Hypospadias is a congenital defect that is believed to result due to a hormonal imbalance between the 8^th to 15^th week of gestation. This malfunction in hormonal action results in abnormal urethral development.

While the exact cause of hypospadias is unknown, experts suggest genetic and environmental factors play a role in its development as well.

• Risk Factors Associated with Hypospadias

Risk factors associated with the condition may include:

Family history: More common in male infants with a family history of hypospadias

Genetics: Some gene variations may play a role in the disruption of hormones that stimulate male genitalia formation

Maternal age over 35: Some research suggests that women over 35 years of age have an increased risk of giving birth to boys with hypospadias

Exposure to particular substances during pregnancy: There is a suspected association between hypospadias and the mother’s exposure to certain compounds such as hormones, pesticides, or chemicals, but further investigation is needed to confirm the association

• Complications Associated with Untreated Hypospadias

If left untreated, hypospadias may result in the following complications:

• Impaired urination
• Impaired ejaculation
• Abnormal appearance of the penis
• Abnormal curvature of the penis with erection

• Diagnosis of Hypospadias

Hypospadias can be diagnosed with the help of a physical exam. Your child may be referred to a pediatric hypospadias surgeon for further evaluation.

• Treatment of Hypospadias

The treatment adopted for hypospadias depends on the severity of the condition. Minor variants of the ailment do not require surgery. However, most cases of hypospadias require surgical intervention to reposition the urethral opening, straighten the penile shaft, and remove an excess foreskin. Hypospadias repair surgery is typically performed between the ages of 6 to 12 months.

If the penis appears abnormal in any way, circumcision should be avoided. If the condition is diagnosed during circumcision, the procedure should be completed as planned.

• Hypospadias Repair Surgery

Most variants of hypospadias are corrected in a single surgery. However, some forms of the condition require more than one surgery to correct the birth defect.

If the meatus is located near the base of the penis, tissue grafts from the penile foreskin or from the inside of the mouth may be used to reconstruct the urinary channel in its proper position.

Hypospadias repair surgery is a low-risk procedure, and the surgery is successful in most cases. The penis looks normal after surgery, and patients report normal urination and reproduction.

In rare cases, a hole, or fistula, may develop on the underside of the penis where the new urinary channel has been created. This fistula results in urine leakage. Occasionally, there are reports of scarring, which may require additional surgery for correction.

• Post-Operative Complications

Post-operative care after surgery is critical. Possible complications that may involve after the procedure include:

• Bleeding
• Infection
• Bladder spasms
• Fistula formation
• Stricture or stenosis
• Recurrent chordee
• Diverticulum

• Post-Operative Care

You will be required to go for at least two to three follow-ups after the procedure.

After the initial healing period is complete, regular follow-ups with the patient are recommended when the child is toilet training. Moreover, another consultation is advised at puberty to check for healing progress and the diagnosis of any possible complications.

• Parting Thoughts

While mild cases of hypospadias may not require surgery, it is best to consult a specialist to find the best solution for your child. Do not hesitate if you have any questions in mind. Be sure to do your own research so you can prepare your queries beforehand.

Hypospadias is easily curable. Make sure your child gets the best care for him.