In hypospadias, instead of the opening at the tip of the urethra, the opening is on the underside of the penis, causing the urethra to flow out of the body without opening. A male with hypospadias may have a curved urethra, a short or narrow foreskin, or no foreskin. It affects about one in 200 male births and is one of the most common birth defects.
The exact cause of hypospadias is unknown, but it is believed to be a combination of genetic and environmental factors. Some possible risk factors include:
Family history of hypospadias or other genital anomalies
Maternal age over 35 years or under 20 years
Maternal exposure to certain hormones, such as progesterone or anti-androgens, during pregnancy
Maternal exposure to certain chemicals, such as pesticides, herbicides, or plasticizers, during pregnancy
Maternal smoking, drinking, or drug use during pregnancy
Premature birth or low birth weight
Hypospadias may vary in severity depending on the location and extent of the urethral opening. The most common types of hypospadias are:
Subcoronal, in which the opening is near the head of the penis
Midshaft, in which the opening is along the shaft of the penis
Penoscrotal, in which the opening is at the base of the penis or in the scrotum
The symptoms of hypospadias may include:
Abnormal appearance of the penis, such as a hooded or bifid glans, a ventral curvature (chordee), or a webbed penis
Abnormal urination, such as spraying, dribbling, or difficulty aiming
Abnormal ejaculation, such as reduced force or volume
Reduced fertility, due to impaired sperm delivery or quality
Reduced sexual function or satisfaction, due to pain, discomfort, or embarrassment
Hypospadias can be diagnosed by a physical examination of the penis and the urethra. The doctor may also order other tests to evaluate the function and anatomy of the urinary and reproductive systems, such as:
Urinalysis, which involves testing a sample of urine for signs of infection, inflammation, or blood
Ultrasound, which uses sound waves to create images of the kidneys, bladder, ureters, and urethra and detect any abnormalities or obstructions
Urethrography, which involves injecting a dye into the urethra and taking X-rays to visualize the shape and length of the urethra and detect any strictures or fistulas
Cystoscopy, which involves inserting a thin tube with a camera and a light into the urethra and bladder and inspecting the inner lining and walls for any lesions or defects
Depending on the type, severity, and symptoms of hypospadias, the main goal of treatment is to correct the appearance and function of the penis and urethra while preventing any complications.
Surgery, which involves reconstructing the urethra and glans, straightening the penis, and restoring the foreskin. The surgery is usually performed between 6 and 18 months of age, when the penis is still growing and anesthesia is safer. Depending on the complexity of the repair, surgery may require more or less stages. The condition can also be treated later in life if it was not detected or treated earlier, or if the previous surgery was not satisfactory.
Medications, such as antibiotics, anti-inflammatory drugs, or painkillers, which may be prescribed before or after surgery to prevent or treat any infections, inflammation, or pain
To facilitate the repair of the penis, hormone therapy involves applying a cream or gel of testosterone or dihydrotestosterone to the penis before surgery.
Counseling, which may be offered to the patient and the family to provide information, support, and guidance on how to cope with the condition and the treatment
Hypospadias cannot be prevented, but some steps can be taken to reduce the risk of having a baby with hypospadias, such as:
Getting regular prenatal care and screening tests, such as fetal ultrasound, to detect any genital anomalies early and plan for the best treatment options
Avoiding exposure to any hormones, chemicals, or substances that may affect the baby’s genital development during pregnancy
Quitting smoking, drinking, or drug use during pregnancy
Seeking genetic counseling or testing if there is a family history of hypospadias or other genital anomalies
The condition of hypospadias is treatable with proper diagnosis and treatment. One can overcome the challenges and complications of hypospadias by following the doctor's advice and treatment plan, as well as getting support from family, friends, and health care professionals.
