Hypospadias (pronounced hypo-spay-dee-us) is a congenital issue where the urethral opening, or urine tube on the penis, is abnormally located below the tip of the penis. The majority of hypospadias is classified as distal, or where the urethral opening is just below the head of the penis and most of the urethra is normal. However, there is a wide spectrum of hypospadias. Mild hypospadias is when the urethral opening is just below the tip of the penis. Very severe hypospadias is when the opening is at the level of or below the scrotum.
Hypospadias also can be associated with curvature of the shaft of the penis (called chordee) or abnormalities of the foreskin. Many children with hypospadias will have a partially-formed or hooded foreskin with deficient skin on the bottom side of the penis where the urethra is located.
Most hypospadias will be recognized shortly after birth due to the appearance of the penis and foreskin. Newborns with a mild form of hypospadias may have a normal-appearing foreskin. The abnormality may only be diagnosed after a neonatal circumcision is performed or later in life if the family chooses not to have the baby circumcised at birth.
Most forms of hypospadias will require surgical correction in order for the child to have normal urinary and sexual function later in life, but some of the mildest forms of hypospadias may not necessarily need surgery since it may not be an issue unless the family requests that a circumcision be done as well.
Newborns with hypospadias are usually seen by pediatric urologist within the first few months. Surgical repair of hypospadias is typically done between 6 to 12 months of age, depending on the health of the baby and any other medical issues. A urethral catheter that drains urine into the diaper is used during surgery and for a short time after hypospadias repair to allow for healing.
Most surgeries are done on an outpatient basis, although older children may need admission to the hospital after surgery if they have significant post-operative pain issues.
In more severe forms of hypospadias, more than one surgery may be necessary with increased risks and complications. Most boys with any significant degree of hypospadias cannot be circumcised at birth due to the abnormalities of the urethra and foreskin but this will be done later at the time of the hypospadias repair in the operating room.