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Hypospadias

Published by Bupa's health information team, July 2008.

This factsheet is for parents of children who have hypospadias, or for people who would like information about it.

Hypospadias is a condition that affects the development of your son's urethra. It's present from birth and affects approximately one in 400 newborn boys in the UK.

• About hypospadias
• Symptoms of hypospadias
• Complications of hypospadias
• Causes of hypospadias
• Diagnosis of hypospadias
• Treatment for hypospadias
• Questions and answers
• Related topics
• Sources

About hypospadias

Hypospadias is a congenital condition (present from birth) which affects the development of your son's urethra. The urethra is the tube for passing urine and semen out of the body. It runs from the bladder through the prostate gland and along the centre of the penis.

During pregnancy, your son's penis grows in length with the urethra developing inside extending to the tip (glans). However, sometimes the urethra doesn't develop properly leaving the opening (meatus) short of the tip of the penis - this is called hypospadias.

There are a number of different types of hypospadias, depending on where the opening is positioned:

• glanular hypospadias - within the head of the penis (glans)
• coronal and subcoronal hypospadias - just below the glans
• penile hypospadias - on the shaft of the penis
• penoscrotal hypospadias - close to the scrotum (the loose bag of skin containing the testicles that hangs below the penis)

The position of the opening also means your son may have a:

• hooded foreskin - the foreskin doesn't develop properly on the underside of your son's penis, creating a hood of skin at the top
• chordee - the skin on the underside of your son's penis is too tight so it appears bent, especially when it's erect

The further back the opening is, the more severe these may be.

Symptoms of hypospadias

There are no symptoms associated with hypospadias. You may notice that your son's urine doesn't come out of the tip of his penis. However, this can be difficult to spot if your child is in nappies or the condition is very minor.

As your son gets older, he may find it difficult to direct his urine stream and need to sit down to urinate. Also, his erections may be bent and uncomfortable, making sexual intercourse in adulthood difficult.

Complications of hypospadias

Hypospadias can be associated with other conditions, most commonly:

• undescended testes - this is when your son's testicles don't move down into the scrotum where they should both be by the time he is a year old
• inguinal hernia - a lump in the groin that occurs when part of the intestine pushes through a weakness in the muscles of the abdominal wall

Very rarely a combination of hypospadias and undescended testes can indicate an intersex condition. This is when an underlying disorder of sexual development causes uncertainty over the gender of a child.

Causes of hypospadias

The exact causes of hypospadias are not fully understood at present. However, it's thought to be related to:

• genes - it may be passed down in families
• hormones a child is exposed to while in the mother's womb
• environmental oestrogens - chemicals present in some pesticides and other substances used to grow and preserve foods

Over the past few decades, the number of boys born with hypospadias has increased in the UK and other parts of the world. The exact reasons for this are not clear at the moment.

Diagnosis of hypospadias

Usually hypospadias is picked up during your son's first baby check (postnatal examination). However, if he has only very minor glanular hypospadias, it may not be diagnosed until he is older.

If you have any concerns about your son's penis you should see your GP. He or she will examine your son and ask you about any symptoms.

Once your son has been diagnosed with hypospadias, he will be referred to a paediatric urologist for treatment. A paediatric urologist is a doctor who specialises in identifying and treating conditions of the urinary tract in children.

Treatment for hypospadias

If your son has only minor glanular hypospadias, he may not need any treatment other than regular monitoring. Every other type of hypospadias is treated using corrective surgery.

Surgery is commonly carried out when your son is 10 to 18 months old. Alternatively it can be done at around four years of age, shortly before your son starts school. However, some parents have been opting to leave the operation until their son is old enough to decide for themselves. It's important not to have your son circumcised before he has corrective surgery for hypospadias as the foreskin may be used during the procedure to extend his urethra.

The operation involves creating a urethral opening at the tip of his penis, straightening his penis and, in general, making it look as normal as possible. With minor hypospadias, these procedures can be carried out during one operation. However, with more severe hypospadias, two separate operations may be needed. These usually take place six months apart.

The operation usually takes place as a day case under general anaesthetic. If your son is having a general anaesthetic, you will be asked to ensure he follows fasting instructions. Typically he must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.

After surgery, your son will have a thin, plastic tube (catheter) draining urine from his bladder and his penis will be covered with a dressing. These will usually need to stay in place for one week after the operation. The hospital will give you instructions about how to look after your son's catheter and dressings until they can be removed. You will be given a follow-up appointment for this before you go home.

Related topics

• Hypospadias surgical correction
• Caring for surgical wounds
• General anaesthesia

Sources

• Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2007
• Davenport M. ABC of General Surgery in Children: Problems with the penis and prepuce. BMJ. 1996; 312: 299-301
• Hypospadias. eMedicine. www.emedicine.come, accessed 21 April 2008
• Hypospadias. GP Notebook. http://gpnotebook.co.uk, accessed 21 April 2008
• Urogenital Reconstruction, Penile Hypospadias. eMedicine. www.emedicine.com, accessed 25 April 2008

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Mr Mark Woodward MD FRCS (Paed) Consultant Paediatric Urologist, Bristol, and by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: July 2008