What is hypospadias?

Pretty much, hypospadias is a congenital condition in males in which the opening of the urethra is on the underside of the penis.

One out of every 350 boys

First off, what is hypospadias? Hypospadias is a common birth defect, occurring in approximately 1 in 350 baby boys. Most often it’s the only problem, and doesn’t imply other defects exist in the urinary system or other organs. Hypospadias is a condition in which the urethral opening does not form completely at the tip of the penis. Instead, the opening may be located anywhere along the underside of the penis. While with the majority of cases, the urethral opening is located near the head, a position referred to as distal, it also may be located from the middle of the penile shaft to the base of the penis or even behind the scrotum. This is called proximal. Over 80 percent of boys with hypospadias have distal hypospadias. In 15 percent of these cases, a mild downward curvature of the penis exists. This is called chordee. When the urethral opening is located more proximally and father down the shaft, curvature occurs in more than 50 percent of the cases.

Usually hypospadias is apparent at birth. Not only is the urethral opening in the wrong position, but the foreskin typically is incompletely developed, resulting in what’s called a “dorsal hood” or just “hooded”, that leaves the tip of the penis exposed. This appearance of the foreskin most often calls attention to the condition after birth. Some baby boys have an abnormal foreskin with a normal urethral opening, others have a complete foreskin with an abnormal urethral opening, and the more severe have both, and in many of these cases have chordee as well. Some boys with hypospadias also have a testicle that is not fully descended into the scrotum at the time of birth. The incidence of this increases with the severity of the hypospadias.

How is hypospadias treated?

Physicians have been correcting hypospadias with surgery since the 1800s. Since that time, technique has naturally improved a great deal. From the 200 types of operations used in the past, only a handful of techniques are employed pediatric urologists since the 1980s.

Regardless of approach, the goal with hypospadias surgery is to create a normal and straight penis with a urinary opening at the tip of the penis. Hypospadias surgery usually involves four steps: straightening the shaft (when chordee is present), creating the urinary channel, positioning the urethral opening at the head and either circumcising or reconstructing the foreskin.

Hypospadias surgery is usually accomplished in approximately ninety minutes for mild, or distal hypospadias, and three hours for severe, or proximal hypospadias. The surgery is outpatient unless a graft is taken, in which case an overnight hospital stay may be needed. With more severe cases, hypospadias surgery is often done in stages. This is usually when the surgeon wants to straighten the shaft before constructing the urinary channel.

Doctors prefer to do hypospadias surgery between the ages of 6 and 18 months. Yet the repair can be corrected at any age.


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