Pediatric Urology - Hypospadias
Hypospadias is one of the more common birth abnormalities of the genitalia in male infants, but most families are not aware of it since the condition is rarely talked about. In a normal penis, the urine tube (urethra) travels through the shaft of the penis to an opening (meatus) located in the center of the head of the penis (glans). In boys with hypospadias, the urine tube is short and does not come out to the end of the penis. The opening could be located anywhere along the underside of the shaft of the penis or even in the scrotum. In addition, the foreskin – the loose skin that surrounds the head of the penis that is removed during circumcision – is incompletely formed and there may be a bend in the penis called a chordee. Most children with hypospadias have no other abnormalities, although inguinal hernias and undescended testes are more common in children with hypospadias than in the general population.
Diagnosis of Hypospadias
Hypospadias develops during pregnancy and its exact cause is unknown. It is usually identified during the baby's initial physical examination, and the first clue is often the abnormal foreskin. However, there are some cases of hypospadias in which the foreskin is completely normal and doctors do not diagnose the condition until the foreskin is retracted or the boy has been circumcised. Fortunately, almost 90 percent of hypospadias cases are minor with the urethral opening on or just below the head of the penis. In the remaining cases there is likely to be some degree of functional difficulty with both voiding and sexual activity.
Treatment for Hypospadias
Boys with hypospadias should have surgery to ensure that the opening (meatus) is far enough out on the shaft for a man to stand to urinate and to ensure insemination (fertilization). The penis must be straight enough with erection to assure penetration during intercourse and the penis must be cosmetically acceptable to the child. Most surgeons recommend surgery when the child is between 6 and 12 months old.
Hypospadias repairs are outpatient procedures and usually very successful, especially when they are performed by an experienced surgeon. During the operation, the surgeon will correct the chordee (the bend), create a new urethra that extends to the tip of the penis, create a covering for the new urethra, and create an opening (meatus) at the tip of the penis. In more than 90 percent of patients, surgeons can correct the problem in a single operation. But no single method of repair suffices for all patients.
It is important – especially in severe cases of hypospadias – that the child is not circumcised before the repair because the tissue from the foreskin is often essential.
Herbert Irving Pavilion & ColumbiaDoctors Midtown
Morgan Stanley Children's Hospital of NewYork-Presbyterian