Hypospadias

What is Hypospadias?

Hypospadias is the most common congenital birth defect of the penis, affecting about 1 in 300 newborn boys. It is the abnormal location of the urethral opening on the penile shaft (usually on the underside of the penis), and is frequently found with other defects like penile curvature and incomplete or hooded foreskin. It can be very mild and purely aesthetic or cause severe functional disorders including mental and social health problems, if not treated early. The majority of boys with hypospadias have no other health problems. Hypospadias are not associated with sexual development disorders.

The pediatric urologists at Children’s Hospital at Erlanger have significant skill and experience in the surgical techniques to repair this defect. The goal of surgery is to create a normal appearing, straight penis with a urethra opening as close to the tip of the penis as possible to allow urination in a standing position. This will allow for a properly directed urinary stream, a straight penis on erection, and a cosmetically acceptable appearance.

What Are the Risk Factors?

• 20% of cases have an affected relative
• Low birth weight
• Twins or triplets
• In Vitro Fertilization is associated with an increased risk of hypospadias
• Undescended testes are associated with hypospadias

What is the Cause?

• The cause is generally poorly understood
• It results from incomplete development of the urethra in utero
• Genetic factors play a role in cases where there is a family history

How is it Diagnosed

Hypospadias is present at birth. The diagnosis is generally made during physical examination of your newborn at birth. You will be asked if there is a family history of this condition.

Is Surgery Necessary?

Surgery is the only treatment available. Your child will not outgrow this condition. These facts should be considered in making your decision:

• Even if the hypospadias is mild, as many as 15% of boys with hypospadias will have a noticeable downward curvature of the penis that may interfere with the ability to achieve an effective erection in adulthood. In the worst cases fertility may be affected. Also, if the opening is on the underside of the penis, the child may be unable to stand to urinate like other boys. This will affect his social development.
• The urethral opening may be in the correct position but may be misshapen or enlarged, or a web of skin may be behind the opening. All of these factors can disturb the urinary stream causing some boys to spray to the side or downward. The penis functions but these problems can be embarrassing.
• Any potential defect must be balanced against the likelihood of successful surgery. But most pediatric urologists will recommend surgery for all but the most minor problems.
• The exact surgical technique will depend on the degree of hypospadias, and the extent of penile curvature. So you need a pediatric urologist with special skills, training and expertise. The extent of the needed repair can only be determined once the surgery has begun.
• The vast majority of these surgeries are successful the first time.
• Surgery carries with it the usual risk of infection, which will be controlled with antibiotics. Bleeding is usually minimal. Good surgical technique will minimize complications.

Timing of Surgery

Current thinking is that the best time for surgical correction is between 4-6 months based on physical, psychological and technical considerations. This has been associated with an improved emotional and psychological result. Later age repair has been associated with complications and significant psychological problems.

Surgery

There are a variety of surgical approaches. No single technique is appropriate for all repairs. The surgical choice will depend on the degree of severity and location of the hypospadias. Your Children's Hospital at Erlanger surgeon will discuss the options with you.

At Children's Hospital at Erlanger, our pediatric urologists understand how difficult it is to consider surgery for your newborn. We will answer all your questions and support you through the process. We will provide you with comprehensive, patient-centered care in a clean, calm, safe environment.