Hypospadias

In hypospadias, the opening of a boy’s urethra (through which both urine and semen pass) is located on the underside of the penis rather than at the tip. This condition, which is present at birth, affects about one in 200 boys. While very mild forms of hypospadias may not interfere with urinary or reproductive function, most boys with the condition will require surgery. When treated by experienced pediatric urologic surgeons, the outlook for infants who undergo this operation is extremely good: In most instances, they make a full recovery and have a normal-looking, fully functional penis within about six months.

If your child requires surgical repair of hypospadias, they should be treated by an experienced pediatric urologic surgeon in a multidisciplinary setting with access to specialists from several different disciplines. Boston Children’s Hospital is a destination for babies with complex hypospadias that requires specialized care, as well as boys who have previously undergone unsuccessful hypospadias repair elsewhere. We take a standardized approach to surgical repair, so you can be confident that your child will receive the same exceptional treatment no matter which of our skilled pediatric surgeons treats him.

In hypospadias, the urethral opening can be located at any point along the underside of the penis. The location of the opening determines the severity of the condition:

• Anterior (distal) hypospadias: The urethral opening is located near the tip of the penis. This is the mildest form of hypospadias, occurring in about 50 percent of cases.
• Middle hypospadias: The opening is located midway up the penis. This accounts for about 30 percent of cases.
• Posterior (proximal) hypospadias: The opening develops at a boy’s scrotum or perineum. This is the most severe form of the condition, and occurs in 20 percent of cases.

Other signs of hypospadias include:

• Downward urinary spray (in older boys with more severe hypospadias, this may mean they have to sit down to urinate)
• Downward curve of the penis, called chordee
• “Hooded” appearance to the penis, caused by extra foreskin along the top side
• Abnormal appearance of the tip of the penis (the glans)

In some cases, boys born with hypospadias may also have undescended testicles, inguinal hernias, or both.

Hypospadias doesn’t cause physical pain or block urination, but left untreated, more severe forms can interfere with sexual intercourse in adulthood.

Hypospadias can only rarely be seen on fetal ultrasound, so doctors typically diagnose it just after the baby is born, during his first physical examination. Because the mildest forms of hypospadias can be overlooked, you should contact your doctor if you notice that:

• Your son’s urethral opening is not at the tip of his penis
• That his penis curves downward (chordee)
• His foreskin is not fully developed

Upon diagnosing hypospadias, your doctor should refer your son to a pediatric urologic surgeon.

Surgery remains the best and only way to correct all but the mildest cases of hypospadias.

A pediatric urologic surgeon can perform the procedure, ideally when your son is between 6 to 12 months old. Although the technique may differ depending on your son’s individual case, the goals of surgery are usually the same:

• To reposition the opening of urethra at the tip of the penis (urethroplasty)
• To straighten the penis, if chordee is present (orthoplasty)
• To improve the outward appearance of the penis (removing the hooded foreskin)

Hypospadias surgery typically lasts one to two hours and occurs under general anesthesia. Unless the hypospadias is severe, the surgeon will complete the repair in one stage. Some more severe cases will require two stages, but that is relatively rare. Depending on the extent of surgery, your child may either go home the same day or stay in the hospital overnight. His clinical team will explain how to care for him during his recovery.