Hypospadias

Topic Overview

What is hypospadias?

Hypospadias is a male birth defect in which the opening of the tube that carries urine from the body (urethra) develops abnormally, usually on the underside of the penis. The opening can occur anywhere from just below the end of the penis to the scrotum.

What causes hypospadias?

In most cases, the cause of this birth defect is not fully understood. Treatment with hormones such as progesterone during pregnancy may increase the risk of hypospadias. Certain hormonal fluctuations, such as failure of the fetal testes to produce enough testosterone or the failure of the body to respond to testosterone, increase the risk of hypospadias and other genetic problems.

What are the symptoms?

Mild hypospadias usually does not cause symptoms, especially in newborns and young children. If it's more severe, a male may have problems such as spraying urine, having difficulty directing the urine stream, and having erections that are not straight. In some cases, this defect may make it impossible to urinate while standing.

Boys with hypospadias are also more likely to have an undescended testicle.

How is hypospadias diagnosed?

Hypospadias is usually diagnosed during the physical exam of a newborn. A test that may be useful if severe hypospadias is suspected is an excretory urogram. This test uses X-rays to provide pictures of the urinary tract. It may be used to check for other congenital abnormalities of the kidneys or the tubes that carry urine from the kidneys to the bladder (ureters).

How is it treated?

Hypospadias is sometimes treated with surgery to correct the placement of the urethral opening, usually during the first year of life. There are several different types of surgery. These may include repositioning of the urethra, correcting the placement of the urethral opening in the head of the penis, and reconstructing the skin of the area around the urethral opening. The foreskin may be needed for surgical repair. So a baby with hypospadias should not be circumcised.

Complications are more likely to occur in older children and adults. They can include bleeding, infection, narrowing of the urethra (stricture), and curvature of the penis.

Most males are able to urinate successfully from a standing position after surgical treatment of this condition.