Hypospadias

The nationally ranked Division of Urology at Lurie Children’s is experienced in treating hypospadias, a condition in which the end of the urethra (the tube in the penis through which urine passes out of the body) is not located at the tip of the penis. The condition occurs in approximately 1 out of 200 newborns. 

In more than two-thirds of cases, the defect is located near the end of the penis where the abnormal opening is located either within the glans (the head of the penis) or just below the glans on the underside of the penile shaft. In more severe forms of hypospadias, the opening is located further down on the penile shaft or in the scrotum. 

Hypospadias is associated with chordee, where the penis curves in a downward direction. Usually, hypospadias is also associated with an incomplete foreskin, which is usually recognized when a newborn is examined. However, in some cases, hypospadias can occur with a full foreskin and is only recognized at the time circumcision is being performed or after the circumcision has been completed. In many cases, hypospadias is the only genital difference that is seen. But, in some children with hypospadias there may be other genital conditions like undescended testes (UDT, or cryptorchidism), in which’s a baby’s testes do not descend properly to the scrotum. 
Lurie Children’s pediatric urology experts work together to find the best treatment options for each patient. 

What are the Different Types and Severities of Hypospadias? 

There are several ways to classify the severity of hypospadias. This can be done based on the location of the opening of the urethra, or how much penile curvature is noted. 

• Distal (closer to the tip): The most common and mildest form, with the urethral opening near the tip of the glans (head) of the penis or just below the glans 
• Midshaft: Opening occurs along the middle shaft of the penis. 
• Proximal: The most severe form where the opening is at the junction of the penis and scrotum or on the underside of the scrotum. This type often has the most severe degree of penile curvature.  

How Does Hypospadias Affect a Child? 

The effects of hypospadias can vary depending on the severity of the condition. Some children experience: 

• Urinary issues: The abnormal opening can lead to spraying or bending of the urine stream, making it difficult to aim and potentially causing irritation. 
• Curved penis: In some cases, the penis may be bent downwards because of the abnormal development. 
• Psychological impact: As they grow older, boys with hypospadias might experience concerns about appearance and self-esteem due to the condition. 

What Causes Hypospadias?

The exact cause of hypospadias is unknown in most cases. However, it's believed to be a combination of genetic and environmental factors (medications, hormonal exposure, or environmental exposures). 

How Is Hypospadias Diagnosed? 

Hypospadias is typically diagnosed during a physical examination shortly after birth. Doctors are trained to identify the characteristic signs of hypospadias such as an atypically located urinary opening, incomplete foreskin on the underside of the penis and downward curvature of the penis (chordee.) 

In some cases, hypospadias may be diagnosed prenatally (before birth) during a routine ultrasound if the doctor suspects abnormalities in the development of the penis. However, this is less common. 

How is Hypospadias Treated? 

Surgery 

Surgery for hypospadias may be done for functional reasons, as well as cosmetic and potential psychological concerns. Not all cases of hypospadias require correction. The two major functional reasons to perform surgery are to correct deflection of the urinary stream and potential sexual dysfunction later in life due to penile curvature. Cosmetic concerns are closely linked to potential psychological repercussions and the child's perception of the genitalia later in life. If surgical correction is chosen, it is often performed between 6 to 12 months of age.

Type of Surgery 

In most routine cases of hypospadias, where the opening is located closer to the tip of the penis, the opening defect and associated curvature can be corrected in a single outpatient operation. In these cases, more than 90% of the surgeries are successful. However, in more severe cases, two or more surgeries may be required to correct the penile curvature and move the opening of the urethra. In these severe cases, overall success rates are lower and surgical complications are greater. 

The goals of hypospadias surgery are: 

• To move the opening of the urethra to the tip of the penis 
• To correct the penile curvature 
• To achieve an adequate cosmetic outcome 

In some cases, your surgeon may elect to pretreat your child with male hormone treatments (topical cream or shots) that temporarily enlarge the penis and enhance its blood supply. These temporary changes enhance the ability to achieve a successful surgical result. The use of this preoperative hormone treatment is reversible and has been shown to be safe. 

What is the Long-Term Outlook for Children with Hypospadias? 

Generally, the long-term outlook for children with hypospadias is positive. 

Factors affecting the long-term outlook: 

• Severity of the condition: Milder cases typically have better outcomes than severe ones. 
• Effectiveness of treatment: Successful surgery can significantly improve urinary function, and penile appearance. 
• Presence of complications: Some surgical complications can affect long-term outcomes. 
• Psychosocial support: Addressing potential emotional and social challenges related to the condition can be crucial. 

Potential long-term effects:

• Urinary function: Most children with hypospadias achieve a normal or near-normal urinary stream after successful surgery. However, occasional spraying or difficulty aiming might persist in some cases. Children will require continued follow-up visits with their surgeon to ensure no complications arise into adolescence and adulthood.  
• Fertility: Fertility is typically not affected in milder cases, but it might be impacted in severe penoscrotal or perineal hypospadias. Consultation with a urologist for specific fertility concerns is important. 
• Sexual function: Most boys experience normal sexual function after corrective surgery. However, concerns about appearance or penile curvature might lead to some psychological or functional difficulties in adulthood. Open communication with a healthcare professional can address these concerns effectively. 
• Psychological well-being: Early support and education can help children adjust to the condition and cope with any emotional challenges.