Hypospadias

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

This information has been written for parents of boys who have hypospadias.

About hypospadias

Hypospadias is a congenital condition, which means it's something you're born with. About one in 300 boys in the UK are born with hypospadias. Hypospadias 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.

If your son has hypospadias, it means the opening through which urine is passed doesn't come out at the tip of your son's penis, but instead, opens at a point somewhere on the underside 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 head of his penis.
• 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 – about seven out of 10 boys with the condition have one of these 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 deeper layers of tissue under the skin on the underside of your son's penis are too tight so it appears bent, especially when it's erect

The further away from the tip of the penis the opening of your son's urethra is, the more severe these problems may be, resulting in more complex surgery being needed to correct the condition.

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, leading to spraying or dribbling, and may 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. More research is needed to confirm the various theories that have been suggested but it's thought that the following factors may be involved.

• Genes – the condition may be passed down in families.
• Environmental factors, such as chemicals that mimic hormones (chemicals produced naturally by your body) 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.

It’s thought that hypospadias may be caused by a combination of genetic and environmental factors.

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 is older. See our frequently asked questions for more information.

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 to 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 surgery to correct the condition. Surgery for hypospadias is commonly carried out when your son is aged between four and 18 months. Surgery can be done when your son is older so he can decide for himself, and even once he reaches adulthood. However, there appears to be a greater risk of complications when the surgery is left until later. Doing surgery later may also lead to psychological problems related to sexuality.

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 further operations, which are done a few months apart. See our frequently asked questions for more information.

Special considerations

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

Produced by Polly Kerr, Bupa Health Information Team, November 2012.

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

For sources and links to further information, see Resources.