Hypospadias

Published by Bupa's Health Information Team, October 2010.

This factsheet is for parents of boys who have hypospadias, or people who would like information about it.

Hypospadias is a condition that affects the development of the urethra - the tube that carries urine from the bladder to the outside of the body. It causes the opening of the urethra to develop in the wrong place.

About hypospadias

Hypospadias is a condition that baby boys are born with. Around one in 300 boys in the UK are born with hypospadias. It affects the way the urethra develops. The urethra is the tube that passes urine and semen out of the body. It runs from the bladder through the prostate gland and along the centre of the penis.

While in the womb, your unborn son's penis grows in length, and his urethra develops inside. Hypospadias means that your son's urethra doesn't develop properly and the opening (meatus) through which urine is passed doesn't come out at the tip of your son's penis. Instead it opens at another area of his penis.

Types of hypospadias

There are several different types of hypospadias, depending on where the opening of your son's urethra is positioned:

• glanular hypospadias - the urethra is within the head of his penis (glans)
  
• coronal and subcoronal hypospadias - the urethra is just below the glans
  
• penile hypospadias - the urethra is on the shaft of his penis
  
• penoscrotal hypospadias - the urethra is close to his scrotum (the loose bag of skin containing his testicles)

Glanular, coronal and subcoronal hypospadias are the most common types.

If your son has hypospadias, he may also have other associated problems, including:

• hooded foreskin - the foreskin doesn't develop properly on the underside of your son's penis, creating a hood of skin at the top
  
• chordee - the skin on the underside of your son's penis is too tight so it appears bent, especially when it's erect

The further back the opening of your son's urethra is, the more severe these problems may be.

Symptoms of hypospadias

You may notice that your son's urine doesn't come out of the tip of his penis. However, this can be difficult to spot if your child is in nappies or the condition is very minor. If you're concerned, talk to your GP.

As your son gets older, he may find it difficult to direct his urine stream and need to sit down to pass urine. Also, his erections may be bent and uncomfortable, making sexual intercourse in adulthood difficult.

Complications of hypospadias

Hypospadias can be associated with other conditions, most commonly:

• undescended testes - this is when your son's testicles don't move down into the scrotum, where they should both be, by the time he is one year old
  
• inguinal hernia - this is a lump in your son's groin that happens when part of his intestine pushes through a weakness in the muscles of his abdominal wall

Very rarely, a combination of hypospadias and undescended testes can be a sign of an intersex condition. This is when an underlying sex development disorder causes uncertainty over the gender of a child. Speak to your GP for more information.

Causes of hypospadias

The exact causes of hypospadias aren't fully understood at present. However, it's thought that it could be related to the following factors.

• Genes - the condition may be passed down in families.
  
• Environmental factors, such as chemicals that mimic our hormones or interfere with the way they work. These chemicals can be found in some everyday products, such as plastics, pesticides and some foods and drinks such as soy products and cows milk.
  
• Being exposed to certain hormones in the womb. Boys are five times more likely to have hypospadias if they were conceived through in vitro fertilisation (IVF).
  
• Being born prematurely with a low birth weight. However, the exact reasons for this aren't understood.

Diagnosis of hypospadias

Usually hypospadias is picked up during your son's first medical check (postnatal examination). However, if he has only very minor glanular hypospadias, it may not be diagnosed until he's older.

Once your son has been diagnosed with hypospadias, he will be referred to a paediatric urologist for treatment. A paediatric urologist is a doctor who specialises in identifying and treating conditions of the urinary tract in children.

If your son has a more severe form of hypospadias, he may need to have an ultrasound scan to examine his kidneys and bladder and check they are working properly.

Treatment of hypospadias

If your son has only minor glanular hypospadias, he may not need any treatment other than regular monitoring.

Surgery

More severe types of hypospadias are treated using corrective surgery. Surgery is commonly carried out when your son is aged between 10 and 18 months. Alternatively surgery can be done at around four years of age, shortly before your son starts school. However, some parents choose to leave the operation until their son is old enough to decide for himself.

Surgery aims to:

• create a urethral opening at the tip of your son's penis
  
• straighten your son's penis
  
• allow your son to pass urine standing up
  
• make your son's penis look as normal as possible

If your son has minor hypospadias, he will usually only need one operation. However, if he has more severe hypospadias, he may need to have two separate operations. These usually take place six months apart.

For more information, please see our factsheet on surgical correction of hypospadias.

Special considerations

Your son's foreskin may be used to reconstruct his urethra during the operation, so it's important that he isn't circumcised before this operation.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.