Hypospadias is a male birth
defect in which the opening of the tube that carries urine from the body (urethra) develops abnormally, usually on the underside
of the penis. The opening can occur anywhere from just below the end of the
penis to the scrotum.
In most cases, the cause
of this birth defect is not fully understood. Treatment with hormones such as
progesterone during pregnancy may increase the risk of hypospadias. Certain
hormonal fluctuations, such as failure of the fetal testes to produce enough
testosterone or the failure of the body to respond to
testosterone, increase the risk of hypospadias and other genetic
Mild hypospadias usually
does not cause symptoms, especially in newborns and young children. If it's more severe, a male may have problems such as spraying urine, having difficulty
directing the urine stream, and having erections that are not straight. In some cases, this defect may make it impossible to urinate while standing.
with hypospadias are also more likely to have an
usually diagnosed during the physical exam of a newborn. A test that may
be useful if severe hypospadias is suspected is an excretory urogram. This test uses
X-rays to provide pictures of the urinary tract. It may be
used to check for other congenital abnormalities of the
kidneys or the tubes that carry urine from the kidneys
to the bladder (ureters).
Hypospadias is sometimes
treated with surgery to correct the placement of the urethral opening, usually
during the first year of life. There are several different types of surgery. These may include repositioning of the urethra, correcting the placement of the
urethral opening in the head of the penis, and reconstructing the skin of the
area around the urethral opening. The foreskin may be needed for
surgical repair. So a baby with hypospadias should not be
more likely to occur in older children and adults. They can include bleeding,
infection, narrowing of the urethra (stricture), and curvature of the
Most males are able to urinate successfully from a standing
position after surgical treatment of this condition.
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Other Works Consulted
McAninch JW (2008). Disorders of the penis and male urethra. In EA Tanagho, JW McAninch, eds., Smith's General Urology, 17th ed., pp. 625–637. New York: McGraw-Hill Medical.
Snodgrass WT (2012). Hypospadias. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 4, pp. 3503–3536. Philadelphia: Saunders.
December 28, 2012
John Pope, MD - Pediatrics
& Peter Anderson, MD, FRCS(C) - Pediatric Urology
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