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Overview

What Is Hypospadias?

Hypospadias is a congenital difference in which the opening of the urethra is not at the usual tip of the penis. It is present at birth and can range from mild to more complex forms. Severity depends largely on where the opening is located and whether the penis has downward curvature. This hypospadias definition also includes related differences in the foreskin or urinary stream.

Symptoms

Signs and Symptoms of Hypospadias

  • Urinary opening below the tip of the penis.
  • Downward curvature of the penis, also called chordee.
  • Foreskin that does not fully surround the underside of the penis.
  • Urine stream that sprays or points downward.
  • Difficulty directing urine while standing as the child grows.

Causes

What Causes Hypospadias?

Hypospadias develops when the penis and urethra do not complete typical formation before birth. The exact cause is often unknown, and no single factor explains most cases. Researchers believe that genetic, hormonal, and developmental influences may sometimes play a role.

  • A family history of hypospadias may increase likelihood.
  • Genetic or hormonal differences during fetal development may contribute.
  • Some pregnancy-related and environmental factors have been associated with risk, although they do not explain most cases.

Risk Factors

Risk Factors for Hypospadias

  • A family history of hypospadias is a nonmodifiable risk factor.
  • Certain genetic or sex-development conditions may be associated with hypospadias.
  • Some studies have found an association with assisted reproductive technology.
  • Older maternal age has been reported as a possible association.
  • Prematurity and low birth weight may occur more often among affected infants.

FOR PARENTS

Associations are not blame

These factors describe associations, not proof that a factor caused hypospadias. Hypospadias is generally not caused by a parent’s actions or by something a parent did during pregnancy.

Complications

Possible Complications of Hypospadias

  • An abnormal urine stream may make urination while standing difficult.
  • Untreated or persistent curvature may affect sexual function later in life.
  • A urethral narrowing can make urination difficult after repair.
  • A urethrocutaneous fistula can cause urine to leak from an unintended opening after repair.
  • Body-image or emotional concerns may develop during childhood or adolescence.

Diagnosis

How Is Hypospadias Diagnosed?

A clinician typically diagnoses hypospadias by examining the location of the urinary opening, the foreskin pattern, penile curvature, and urinary function. Diagnosis is often possible during the newborn physical examination. The clinician may recommend pediatric urology assessment when the anatomy is more complex.

When additional tests may be considered

Severe or proximal hypospadias, an atypical genital appearance, undescended testes, or other developmental findings may prompt referral to pediatric urology. Depending on the examination, the specialist may consider selected hormone, genetic, or imaging tests. These evaluations help clarify anatomy and guide care; they are not needed for every child.

Treatment & Management

Treatment and Management of Hypospadias

Mild cases may be monitored, while repair is considered when the urinary opening, curvature, or foreskin difference affects urination, function, or future concerns. A pediatric urologist can explain whether observation or hypospadias surgery is appropriate. Not every child needs an operation, and the recommendation depends on the child’s anatomy and needs.

What hypospadias repair involves

Hypospadias repair may reposition or reconstruct the urethral opening and correct penile curvature when needed. The surgical approach depends on the location of the opening, the amount of curvature, and available tissue. Some children need one procedure, while more complex repair of hypospadias may require staged procedures.

  • Follow the surgeon’s instructions for catheter, dressing, bathing, and pain medicines.
  • Attend scheduled follow-up visits to assess healing and urinary flow.
  • Contact the surgical team for fever, worsening swelling, uncontrolled pain, inability to urinate, or concerning drainage.

Outlook and Prognosis

Outlook for Hypospadias

Many children with hypospadias have good long-term outcomes, especially when significant urinary or curvature problems are appropriately treated. Recovery and results vary according to the severity of the condition and the complexity of any repair. Ongoing communication with the pediatric urology team helps address concerns as the child grows.

  • Follow-up may assess urinary stream and the appearance and function of the repair.
  • Some children need additional treatment for curvature, fistula, or narrowing.
  • A review during later childhood or puberty may be appropriate after more complex repairs.

When Should You See a Doctor

When Should You See a Doctor?

  • Ask the newborn clinician to assess any urinary opening that is not at the tip of the penis.
  • Arrange pediatric urology evaluation for an abnormal urine stream or noticeable penile curvature.
  • Seek urgent medical care if a child cannot urinate or has severe pain or rapidly worsening swelling.
  • After repair, promptly contact the surgical team for fever, significant bleeding, catheter problems, or worsening wound changes.

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