Hypospadias

Signs and Symptoms

Hypospadias are deformities of the penis resulting from incomplete development of the urethra, the tube that carries urine from the bladder to the penis. It can occur in many different ways, including:

• Opening of the urethra below the tip on the bottom side of the penis
• Abnormal appearance of the glans penis (the tip)
• Incomplete foreskin in which the foreskin extends only around the top of the penis
• Curvature of the penis during an erection (called chordee)
• Buried penis
• Abnormal position of scrotum with respect to penis

This condition is second only to undescended testes as a congenital abnormality affecting a boy's genitalia. It occurs in 1 in 250 to 300 males born in the United States. There is a family tendency towards hypospadias, with an increased incidence noted in boys whose father or brothers have hypospadias. Other than inherited cases, the cause usually isn't known.

Problems resulting from hypospadias include deviation of the urinary stream, cosmetic and psychological considerations and potential adverse effect on sexual functioning. The best time to repair hypospadias is between the ages of 6 to 15 months, when the psychological effects of genital surgery are minimal. At UCSF Children's Hospital, hypospadias repair is done exclusively on an outpatient basis, minimizing separation of the child from parents and reducing the cost of the procedure.

Diagnosis

Hypospadias is typically diagnosed during a newborn examination. The opening of the urethra is below the tip of the penis. The penis may be curved and the foreskin not completely formed around the entire tip of the penis. Occasionally, a specific type of hypospadias, known as megameatus intact prepuce variant of hypospadias, is not noted until a circumcision has been performed.

Treatment

Surgery is the only treatment available to correct hypospadias. We recommend that these operations be performed between 6 and 15 months of age.

Often, repair can be achieved in a single one- to three-hour operation as an outpatient at UCSF's outpatient surgery center.

If you live outside of the San Francisco Bay Area, we will help make arrangements to spend the nights before and after the surgery at a local hotel so you can call us should any immediate problems arise.

If you have California Children Services (CCS) approval, the agency will help to pay for the accommodations.

The goal of surgical correction is to reconstruct a straight penis with a urethral opening as close to the tip of the penis as possible. This will result in a properly directed urinary stream, straightened penis upon erection and an appearance similar to a circumcised penis.

The surgery is performed under general anesthesia and often your child will be admitted and discharged from the hospital on the same day.

About half of the cases involve the more complicated hypospadias repairs, which requires a catheter to be left in the bladder to drain the urine for seven to 10 days. The surgery requires anywhere from one to three hours depending on the severity of the hypospadias.

For more information about the care of your child after surgery, read our Post-Operative Instructions