Pediatric Hypospadias

Hypospadias is a problem where the opening of the urethra is not at the tip of the penis. The urethra is the tube that carries urine from the bladder to the outside of the body. With hypospadias, the end of the tube is lower down on the underside of the penis. Or it may be in the scrotum. The fold of skin on top of the penis (the foreskin) also forms abnormally. Hypospadias can prevent normal urine flow. Later in life it can cause problems with semen flow. This can lead to not being able to have children (infertility).

Hypospadias is a problem that some boys are born with (congenital). It happens during growth in the mother’s uterus. As the baby grows in the uterus, the tissue on the underside of the penis that forms part of the urethra doesn't fully close. The foreskin doesn’t fully develop. This leaves extra foreskin on the top side of the penis. And no foreskin on the underside of the penis.

A baby is more at risk for hypospadias if he:

• Has an older mother
• Has a father with other conditions of the urinary tract or genitals
• Is born early (preterm birth)
• Has a low birth weight
• Is a twin
• Has a mother who has diabetes during pregnancy (gestational diabetes)
• Was exposed before birth to secondhand cigarette smoke and pesticides

Symptoms can occur a bit differently in each child. They can include:

• Abnormal look of foreskin and penis
• Abnormal direction of urine stream
• End of penis curves downward

The symptoms of hypospadias can seem like other health conditions. Have your child see their healthcare provider for a diagnosis.

The healthcare provider will ask about your child’s symptoms and health history. They may also ask about your family’s health history. The provider will give your child a physical exam. This will include looking at your child’s penis and foreskin.

Treatment will depend on your child’s symptoms, age and general health. It will also depend on how severe the condition is.

Hypospadias can be fixed with surgery. Surgery is often done when a baby is 6 to 24 months old. This is when penile growth is minimal. Your baby should not be circumcised at birth. This is because the foreskin may be needed to repair the penis. In some cases, more than one surgery is needed to complete the repair.

Talk with your child’s healthcare providers about the risks, benefits, and possible side effects of surgery.

If a hypospadias is not repaired, your child may have problems such as:

• Abnormal urine stream. The urine stream may point in the direction of the opening, such as downward. Or it may spray in many directions.
• Curving penis. As your child grows, his penis may curve. This can cause sexual problems later in life.
• Infertility. If the urethral opening is closer to the scrotum or perineum, your child may have problems with fertility later in life.

Call the healthcare provider if your child has:

• Symptoms that don’t get better, or get worse
• New symptoms