Hypospadias

What Is Hypospadias?

The majority of hypospadias is classified as distal, or where the urethral opening is just below the head of the penis and most of the urethra is normal. However, there is a wide spectrum of hypospadias. Mild hypospadias is when the urethral opening is just below the tip of the penis. Very severe hypospadias is when the opening is at the level of or below the scrotum.

Hypospadias also can be associated with curvature of the shaft of the penis (called chordee) or abnormalities of the foreskin. Many children with hypospadias will have a partially-formed or hooded foreskin with deficient skin on the bottom side of the penis where the urethra is located.

When Is Hypospadias Diagnosed?

Most hypospadias will be recognized shortly after birth due to the appearance of the penis and foreskin. Newborns with a mild form of hypospadias may have a normal-appearing foreskin. The abnormality may only be diagnosed after a neonatal circumcision is performed or later in life if the family chooses not to have the baby circumcised at birth.

Is Surgery Required for Hypospadias?

Most forms of hypospadias will require surgical correction in order for the child to have normal urinary and sexual function later in life, but some of the mildest forms of hypospadias may not necessarily need surgery since it may not be an issue unless the family requests that a circumcision be done as well.

Newborns with hypospadias are usually seen by pediatric urologist within the first few months. Surgical repair of hypospadias is typically done between 6 to 12 months of age, depending on the health of the baby and any other medical issues. A urethral catheter that drains urine into the diaper is used during surgery and for a short time after hypospadias repair to allow for healing.

Most surgeries are done on an outpatient basis, although older children may need admission to the hospital after surgery if they have significant post-operative pain issues.

In more severe forms of hypospadias, more than one surgery may be necessary with increased risks and complications. Most boys with any significant degree of hypospadias cannot be circumcised at birth due to the abnormalities of the urethra and foreskin but this will be done later at the time of the hypospadias repair in the operating room.

Hypospadias in Children

What Is Hypospadias In Children?

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).

What Causes Hypospadias In A Child?

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.

Which Children Are At Risk For Hypospadias?

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

What Are The Symptoms Of Hypospadias In A Child?

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.

How Is Hypospadias Diagnosed In A Child?

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.

How Is Hypospadias Treated In A Child?

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.

What Are Possible Complications Of Hypospadias In A Child?

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.

When Should I Call My Child’s Healthcare Provider?

Call the healthcare provider if your child has:

· Symptoms that don’t get better, or get worse

· New symptoms

Key Points About Hypospadias In Children

· Hypospadias is a problem where the opening of the urethra is not at the tip of the penis. The opening may be lower down on the underside of the penis. Or it may be in the scrotum. The foreskin of the penis also forms abnormally.

· It is a problem that some boys are born with. It happens during a baby’s growth in the uterus.

· It can be fixed with surgery. Surgery is often done when a baby is 6 to 24 months old.

· 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.

· If the condition is not repaired, your child may have problems such as abnormal urine flow, a curving penis, and infertility.

Next Steps

Tips to help you get the most from a visit to your child’s healthcare provider:

· Know the reason for the visit and what you want to happen.

· Before your visit, write down questions you want answered.

· At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

· Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

· Ask if your child’s condition can be treated in other ways.

· Know why a test or procedure is recommended and what the results could mean.

· Know what to expect if your child does not take the medicine or have the test or procedure.

· If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

· Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.