By: Julie Cheng, MD, MAE, FAAP
Babies born with hypospadias have differences in the structure of the penis. The opening where urine exits the body (the meatus) is not at the tip or head (glans) of the penis, as usual. Instead, it is located somewhere along the underside of the penis. There may also be other differences.
Here are answers to some common questions parents may have about hypospadias.
How common is hypospadias?
Hypospadias is a fairly common congenital (present at birth) condition of the penis. It has been reported to occur in up to 1-in-125 male births.
What causes hypospadias?
Hypospadias occurs when the urethra (the duct that lets urine flow from the bladder to outside the body) does not completely wrap into a tube when the fetus is developing. This results in an opening on the underside of the penis.
No specific causes of hypospadias have been identified. However, the condition can occur with genetic, hormonal or environmental factors affecting fetal growth and development.
Hypospadias can sometimes be linked to an undescended testicle or other congenital conditions, but most children with hypospadias do not have any other differences in development.
What are other differences children with hypospadias may have?
With hypospadias, there may be less foreskin on the underside of the penis. In addition, children with hypospadias may have "chordee," a downward bend or curve in the penis. It is more noticeable with erections and may affect future sexual function.
What are the symptoms of hypospadias?
Urine can dribble, spray or come out in a different direction (either to the side or downward) instead of coming out as a straight stream. This can sometimes affect the ability to pee standing up.
How is hypospadias diagnosed?
Hypospadias is diagnosed with a physical exam after birth. Your pediatrician, pediatric urologist or pediatric surgeon will check the foreskin, location of the meatus, and any downward bend in the penis.
Are there different types of hypospadias?
You may hear additional terms such as "distal" or "proximal" to describe the location of the meatus. "Distal" means the meatus is closer to the tip of the penis, and "proximal" means the meatus is farther from the tip of the penis and closer to the body.
How is hypospadias managed & treated?
If hypospadias is suspected or detected, your pediatrician may advise against circumcision until your child can be evaluated by a pediatric urologist or pediatric surgeon. Circumcision can make future surgical repair more difficult.
Hypospadias surgery is preferably done starting at 6 months of age. This is when the risk of anesthesia is low, but a child has not started walking or potty training yet. In some more severe cases, more than one operation may be needed.
What is the goal of surgery for hypospadias?
The goal of surgical treatment is for a child to have a straight penis with the meatus located on the head of the penis. This can help with peeing in the standing position and future sexual function.
About Dr. Cheng
 Julie Cheng, MD, MAE, FAAP is an assistant professor of pediatric urology at Oregon Health and Science University. She is affiliated with Randall Children's Hospital and Doernbecher Children's Hospital in Portland, OR. She is a member of the American Academy of Pediatrics Section on Urology.
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