Hypospadias

Definition

Hypospadias is a condition in which the opening of the urethra is on the underside of the penis, instead of at the tip. The urethra is the tube through which urine drains from your bladder and exits your body.

You may feel distressed if your son is born with hypospadias. However, hypospadias is common and doesn't cause difficulty in caring for your infant. In fact, surgery usually restores the normal appearance of your child's penis. With successful treatment of hypospadias, most males can eventually have normal adult sexual function.

Symptoms

In hypospadias, the opening of the urethra is located on the underside of the penis instead of at the tip. The severity of the condition varies. In most cases, the opening of the urethra is near the head of the penis. Less often, the opening is at midshaft or at the base of the penis. Rarely, the opening is in or beneath the scrotum.

Signs and symptoms of hypospadias may include:

  • Opening of the urethra at a location other than the tip of the penis
  • Downward curve of the penis (chordee)
  • Hooded appearance of the penis because only the top half of the penis is covered by foreskin
  • Abnormal spraying during urination

Causes

Hypospadias is present at birth (congenital). In many cases, the cause is unknown. Sometimes hypospadias is inherited.

As the penis develops in a male fetus, certain hormones stimulate the formation of the urethra and foreskin. Hypospadias occurs when a defect occurs in the action of these hormones, causing the urethra to develop abnormally.

Tests

Hypospadias can be diagnosed during a physical examination.

Treatments

Treatment involves surgery to reposition the urethral opening and, if necessary, straighten the shaft of the penis.

What happens during surgery
During surgery, a pediatric urology surgeon uses tissue grafts from the foreskin or from the inside of the mouth to reconstruct the urinary channel in the proper position, correcting the hypospadias. The surgery usually takes from 90 minutes to three hours and is done while the child is unconscious (general anesthesia). Rarely, the repair may be performed in stages, requiring two or more surgeries.

When surgery is performed
Surgery is best at an early age — usually between ages 3 months and 18 months. But the procedure can be completed at any age and even into adulthood. Infants should not be circumcised before the procedure because the foreskin tissue may be needed for the surgery.

Complications of surgery
In most cases, surgical repair results in a penis with normal or near-normal function and appearance and no future problems. However, in a small number of cases, a hole (fistula) may develop along the underside of the penis where the new urinary channel was created. This can result in urine leakage and require an additional surgery for repair.

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