Hypospadias Explained: A Complete Guide

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Apollo Hospital Mumbai
June 27, 2023
Pediatric Surgery

Verified by: Dr. Ashwini Khanolkar, Consultant Pediatric Surgery, Apollo Hospitals, Navi Mumbai.

Hypospadias is a condition in which the opening of the penis is on the underside rather than the tip. It is a birth defect in boys where the opening of the urethra (the tube that caries urine from the bladder to the outside of the body) is not located at the tip of the penis. It is a condition that affects 1 out of every 250-300 male children born. It

This condition is not fatal but can cause numerous side-effects that impair your lifestyle significantly if it isn’t corrected at the right time.

About the disease

In a healthy penis, the urethra carries the urine and sperms from the bladder to the tip of the penis, from where it is excreted in a good stream to fall away from the legs anteriorly.

Patients with hypospadias, this opening of the urethra is not at the tip but forms on the under-surface of the penile shaft anywhere between the end of penis to the scrotum. This is due to an abnormal development phase between 8-14 weeks of pregnancy while the baby is still in mother’s womb. There are different degrees of hypospadias, which determine the severity of the situation.

In short, hypospadias is when the development of the opening at the head of the penis is abnormal or displaced. In most cases, this is present in premature births, but other causes for this condition include:

Genetic defects
Smoking or alcohol consumption during pregnancy causing a defect
Hormones used during fertility treatments
Exposure to pesticides during pregnancy
Maternal weight obstructing nutrient consumption during fetal development

The good news is that this condition is not fatal, and it can be surgically corrected.
Before talking about treatments for this condition, however, let’s first have a look at how to identify hypospadias.

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Symptoms

Hypospadias can manifest in three forms depending on the location of the penile shaft opening. These are:

Sub coronal Hypospadias: This is when the urethral shaft has an opening near the head of the penis.
Midshaft Hypospadias: This is when the opening is anywhere along the shaft of the penis.
Penoscrotal Hypospadias: This is when the location is either on the scrotum, perineum, or in the place where the penis and scrotum meet.

In rare cases, the penis can curve in a downward-facing arch. This condition is called Chordee and can be most clearly observed in a penile erection. This could lead to abnormal spraying of urine, might have to sit to urinate so as to not wet his pants or shoes. If not corrected in time, it can lead to problems in later life, such as difficulty in performing sexual intercourse or difficulty urinating in a standing position.

The location of the opening is the only symptom that can visually be diagnosed. For further investigation, you will be directed to a pediatric urologist by your general physician.

Once the doctors identify the type of hypospadias your child may have, they will recommend an appropriate type of treatment.

Treatment for hypospadias

Treatment is recommended based on the position of the opening. In the case of distal glandular hypospadias, if the position is very close to the head or the original position, doctors may recommend leaving it alone.
No circumcision: The only form of treatment for this condition is surgical. For this reason, depending on the diagnosis, doctors may recommend not performing a circumcision. This is because the surgery is done by using parts of the penile foreskin to repair the shaft opening and redirect the urethral opening to the head.
Age for surgery: Usually done between months to 18 months, but definitely before school going
In case of surgery, the procedure may require the surgeon to straighten the penis as well as moving the urethra. Depending on the type of hypospadias this is done either in a single stage or multi-staged surgery. This is done to help the patient’s urinary stream regulate itself along the shaft to the new urethral opening.
This procedure will requires general anesthesia and cannot be done while the patient is conscious. This is considered a major reconstructive surgery and requires at least 2-3 day admission.
In a majority of cases, the surgery is performed on children aged three months old to 18 months old. If your physician hadn’t diagnosed or performed this surgery on your child or you during this time, it is still safe to perform it on a fully grown adult.
Hypospadias is a relatively safe and straightforward condition for children but can be a more complicated procedure to perform on adults. The chances of success are still high, but the procedure could take longer time.

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Risks & Complications

Hypospadias, if left untreated, can lead to risks like:

Infertility due to difficulty in intercourse.
Urine flow problems
Erectile dysfunction

Dietary Recommendation

The physical nature of the condition cannot be altered through any diet. However, physicians will recommend a light diet with no food intake for a few hours leading up to the surgery. This is standard practice for most surgeries to ensure there are no side-effects caused by the anesthesia used during the procedure.

FAQs

What happens if hypospadias is not treated?

If left untreated, hypospadias can lead to male infertility or fertility problems, a rise in the chances of urinary infections, and problems with the urinary stream.

How do you diagnose hypospadias?

In most cases, hypospadias can be diagnosed visually. The problem is other similar looking conditions like epispadias which lead to misdiagnosis by those who aren’t professionals. To diagnose the condition accurately, visiting a pediatric urologist is a must.