Hypospadias & urethroplasty

What is hypospadias?

“Hypospadias” is the condition in which the urethra opens on the underside of the penis instead of at its tip. About 1 in 300 children is born with some form of hypospadias, and it seems to be becoming more common. Why the penis does not develop properly is still not clear. The development of the penis while the baby grows in the womb depends partly on male sex hormones such as testosterone, and the effects of testosterone on the developing penis may be blocked in some way. Although it is not a hereditary condition, it occurs more often in some families.

Hypospadias: symptoms

• The opening may be slightly below its normal position (mild) or anywhere further along the same line, down to the base of the scrotum (severe).
• The end of the penis usually has a “cobra head” appearance, with the foreskin looking like a hood. This is because the foreskin has not developed on the underside of the penis.
• There may also be “tightening” of the tissues on the underside of the penis, called “chordee”. This pulls the penis downwards and does not let it straighten. The more severe the hypospadias, the greater the chordee.
• The most common problems are a disturbed urinary stream (up to needing to sit to urinate) and curvature of the penis because of the chordee.
• Both lead to problems with appearance and body image, as well as real dysfunction during sex.

Diagnosing hypospadias

The diagnosis is usually obvious on examination of the penis, and there is no other routine test. However, a small number of people with severe hypospadias (when the urethral opening is at the base of the scrotum) may have other genital anomalies. Chromosomal testing (karyotype, microdeletions) is therefore necessary in these cases.

Note: these syndromes are rare, and most boys with hypospadias are genuine “males” with no other anomalies.

Hypospadias & children

• If the hypospadias is mild, with the urethral opening just below its normal position and no curvature of the penis, treatment may not be needed.
• In most cases treatment is surgical and can usually be done in a single operation (one stage).
• If the hypospadias is more severe, two stages may be necessary. Surgery is usually done when the child is about 18–24 months old.