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Hypospadias is a common birth defect in boys that occurs when the urethra, or opening from which urine drains, is not located on the tip of the penis. Babies with hypospadias may have a urinary opening underneath the tip, along the shaft, or near where the penis and scrotum meet. An estimated five out of every 1,000 infant boys born in the United States have hypospadias, according to the Centers for Disease Control and Prevention (CDC).

During pregnancy, a baby’s urethra forms between weeks 8 and 14 of development. A malfunction in the hormones that stimulate the baby’s reproductive system are responsible for causing hypospadias. While the exact cause of this malfunction varies from baby to baby, researchers have identified some risk factors for hypospadias. These include:

  • Being age 35 or older when pregnant.
  • Obesity.
  • Having undergone fertility treatments.
  • Taking hormones before or during pregnancy.

Hypospadias is classified based on where the urethra opens. The three types of hypospadias include:

  • Subcoronal: The urethral opening is located at a point somewhere on the head of the penis.
  • Midshaft: The urethral opening is somewhere along the shaft of the penis.
  • Penoscrotal: The urethral opening is where the penis and the scrotum meet.

Sometimes patients with hypospadias also experience a downward curve of the penis, a condition known as chordee. Baby boys may have an abnormal urine spray due to the urethral opening’s location. Parents of infants with subcoronal hypospadias may not immediately notice the condition, particularly if the foreskin is covering the head of the penis.

Treatment for hypospadias is surgery to re-position the urethral opening and, in patients with chordee, straighten the penis shaft. While hypospadias is not life threatening, it can cause children to have difficulties during potty training. Later in life, men with untreated hypospadias may have difficulty maintaining an erection.

While the appropriate age for surgery varies based on the child and parents’ wishes, a common recommendation from urologists is before the child reaches 18 months old. The foreskin is used as a skin graft to correct the urethral opening. For this reason, circumcision is not recommended for children with hypospadias.

The procedure to correct hypospadias can take several repeat surgeries to fully correct and reposition the urethra. These surgeries may be spaced several months apart and often start with straightening the penis, if necessary. In rare cases, the surgery can result in a fistula or hole where the urethral reconstruction broke down. Some fistulas repair themselves within six months while others may require additional skin grafting.

Takeaways

  • Hypospadias is a condition in males where the urethral opening is not at the tip of the penis.
  • The urethral opening can be where the penis and scrotum meet, on the shaft of the penis, or somewhere on the head of the penis.
  • Surgery is often indicated to correct hypospadias before the baby is 18 months old.
  • If hypospadias goes untreated, men can experience difficulty later in life with maintaining an erection.

References

  1. Centers for Disease Control and Prevention. Facts About Hypospadias.
  2. Mayo Clinic. Hypospadias.
  3. MedlinePlus. Hypospadias.
  4. University of California, San Francisco. Center for the Study & Treatment of Hypospadias.

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