Hypospadias

What is hypospadias?

Hypospadias is an abnormality of the penis, which affects about one in 300 boys at birth.

In this condition, the opening of the urethra (the tube that carries urine and semen out of the body) is on the underside of the penis rather than at the end. The urethral opening may still be on the glans (head of the penis) or further down the shaft.

In some men with hypospadias, there's another abnormality called chordee, in which the penis curves downwards and the foreskin only covers the front of it.

In the most severe forms of hypospadias, the urethral opening is so far back it's almost in the scrotum. The scrotum itself may be small and the testes may not have descended (that is, they're still deep in the abdomen). When babies are born like this, it can be difficult to work out which sex they are without further tests.

Symptoms

Hypospadias is a structural abnormality that doesn't progress or put the man at risk of any other serious illness. However, as with any abnormalities of the urinary system, there may be an increased risk of urinary infection in more severe cases.

Hypospadias may cause emotional turmoil when a boy realises he's different from his friends. It can also cause practical problems with passing urine (those with the condition usually have to sit down to pee) and later with sexual intercourse, which may be embarrassing or difficult to cope with. Hypospadias may cause general worries about sexuality and fertility.

Treatment and recovery

In most cases, a single operation is enough to correct hypospadias. This is usually done before the boy is two (very young children are less traumatised by surgery on the genitalia), but can be done at a later age, even as an adult.

During the operation, the penis is straightened and a tube of skin (or sometimes bladder lining) is used to create a new urethra that goes all the way to the tip of the penis.

It's critical that circumcision isn't performed before this operation, because the foreskin may be needed for the reconstruction.

Surgery is usually successful, allowing the child to urinate normally and later on to enjoy sex.