Hypospadias

What is hypospadias?

Hypospadias is a condition in which the meatus (the opening from which a boy urinates) is not located at the tip of the penis, but somewhere on the underside of the glans or the shaft of the penis.

The severity of hypospadias is classified according to the location of the meatus on the penis. In a baby boy born with hypospadias, the opening can be located anywhere from just below the tip of the penis to the scrotum, and occasionally below the scrotum.

Hypospadias

A curvature of the penis (chordee) may also be associated with the hypospadias.

Causes of hypospadias

We know how to surgically correct hypospadias. We know less about why it occurs.

Hypospadias is present in about 1 out of every 100 boys. It is a congenital anomaly (present at birth). As the fetus develops, the urethral folds do not unite on the midline all the way to the tip of the penis, leaving the meatus (opening part) way down on the glans or shaft. The foreskin does not develop completely, typically leaving a complete foreskin on the top side of the penis and much less or no foreskin on the underside of the penis.

Signs and symptoms of hypospadias

  • Abnormal location of the meatus on the penis
  • Abnormal appearance of foreskin and penis on exam
  • Abnormal direction of urine stream
  • End of the penis may be curved downward

Hypospadias treatment

Each year, the Division of Urology at Children's Hospital of Philadelphia treats more than 1,200 patients who have hypospadias. Hypospadias repair is usually done when your child is between 6 and 12 months old, when penile growth is minimal.

There are many different surgical approaches used to correct hypospadias. The method of hypospadias repair depends on the surgeon, the location of the urinary opening of your child’s penis, and whether other conditions are present. Hypospadias surgery is usually done on an outpatient basis and rarely requires an overnight hospital stay.

Procedures to correct hypospadias include:

  • Meatal advancement and glanuloplasty (MAGPI) repair, a technique pioneered at Children's Hospital of Philadelphia
  • Transverse island flap repair
  • Island tube repair

These techniques, originally described by surgeons at CHOP, have been refined over the years and have significantly improved the surgical outcomes of infants with hypospadias.

At birth, your child should not undergo circumcision, as the extra foreskin may be needed for the surgical repair of hypospadias. The surgeon will use a small piece of foreskin or tissue from another site to create a tube that increases the length of your son's urethra (tube that drains urine from the bladder). Extending the length of the urethra will allow it to open at the tip of the penis.

During surgery, the surgeon may place a catheter (tube) in the urethra to make it hold its new shape. The catheter may be stitched to the head of penis to keep it in place. The catheter will be removed one to two weeks after surgery. The stitches used during surgery dissolve on their own and will not have to be removed later.

We strive to continue to find innovative techniques that will give boys the optimal repair for hypospadias and the best outcomes possible.

Hypospadias surgery outcomes

Almost all cases of hypospadias can be surgically corrected to look and function normally. In most cases, your child’s penis will look like a normal circumcised penis with barely visible scars. This is especially true for more mild cases of hypospadias.

However, there are some children for whom hypospadias is a more serious condition requiring extensive surgical reconstruction. We have particular expertise in working with babies with more complex cases of hypospadias. Our comprehensive team includes pediatric surgeons with years of experience operating on hypospadias, and a psychologist to help children and families cope with the effects of multiple procedures.

Through continued research and experience, the cosmetic and functional outcomes of boys with hypospadias have dramatically improved. 

Follow-up care for hypospadias

We are committed to the long-term care of children with complex hypospadias, following them throughout childhood and adolescence as needed. We specialize in working with children who have undergone failed procedures and are seeking options for reconstruction.

Our dedicated team, including a pediatric psychologist, is available to work with families through toilet training, to help children cope with any procedures necessary as they get older, and to work on issues related to body image, if appropriate.

We are conducting research into genital wound healing to try and identify the factors associated with improved appearance and fewer complications following hypospadias repair.

Long-term care

As your child nears adulthood, our dedicated Urology Transitional Care Program is here to help you and your child prepare for the transition from pediatric to adult medical care. For patients with complex urologic conditions like hypospadias, it is especially important that the care they receive remains effective and streamlined. Learn more about how this collaboration between CHOP and the Hospital of the University of Pennsylvania (HUP) can support you through this process.

Reviewed by: Division of Urology
Date: March 2011

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