Hypospadias

Overview

One of the most common birth defects among boys, hypospadias is caused by the incomplete development of the urethra, the canal that carries urine from the bladder out of the body and also serves as the passageway for semen. The defect results in a urethra that opens on the underside of the penis. In the most serious cases, boys can't urinate normally unless they're treated.

Hypospadias has become much more common in the United States and Europe over the past 30 years, and occurs in one out of every 250 to 300 boys born in the U.S. It's second only to undescended testicles among birth abnormalities affecting a boy's genitalia.

There is a family tendency towards hypospadias, with an increased rate noted in boys whose father or brothers have hypospadias. Other than inherited cases, the cause is usually unknown. Researchers speculate that the increase may be related to exposure to environmental toxins. Some believe that the increase may be due to a greater interest in detecting and reporting the condition.

Fortunately, most boys born with this condition have mild cases that can be repaired relatively easily, with a single outpatient operation performed between the ages of 6 to 18 months.

UCSF experts are skilled at correcting hypospadias, including severe deformities, and over the years we have successfully treated thousands of children born with this condition.

Signs & symptoms

Hypospadias 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

Problems resulting from hypospadias include deviation of the urinary stream, cosmetic and psychological considerations and potential adverse effects on sexual functioning.

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, isn't 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, when the psychological effects of genital surgery are minimal. At UCSF Benioff 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.

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

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 require a catheter to be left in the bladder to drain the urine for seven to 10 days.

For more information about the care of your child after surgery, please see Post-Operative Instructions for Hypospadias Repair.

If you live outside the San Francisco Bay Area, Pediatric Urology will help make arrangements for you 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 pay for the accommodations.