Hypospadias

Hypospadias is a birth (congenital) defect in which the opening of the urethra is on the
underside of the penis.

In this condition the meatus isn't at the tip of the penis. Instead, it may be at any place
along the underside of the penis.

The meatus is most often found near the end of the penis ("distal" position). But it may also
be found from the middle of the penile shaft to the base of the penis, or even within the
scrotum ("proximal" positions).

Epidemiology—

Over 80% of boys with this health issue have distal hypospadias. In 15% of those cases, the
penis also curved downward slightly, a condition called "chordee." When the meatus opens
further down the shaft, curvature occurs in more than 50% of patients. Hypospadias is a
common birth defect found in up to 1 in every 200 boys.

Male Reproductive System

The main roles of the

penis are to carry urine and
sperm out of the
body. The urethra is the
tube that carries urine and
sperm through the
penis to the outside. The
opening to the
outside is called the
"meatus."
The type of hypospadias a boy has depends on the location of the opening of the urethra:

Subcoronal: The opening of the urethra is located somewhere near the head of the penis.

Midshaft: The opening of the urethra is located along the shaft of the penis.

Penoscrotal: The opening of the urethra is located where the penis and scrotum meet.
Causes

Hypospadias occurs in up to 4 in 1,000 newborn boys. The cause is often unknown.

Sometimes, the condition is passed down through families.

Symptoms

Most often, boys with this condition have the opening of the urethra near the tip of the penis
on the underside.

More severe forms of hypospadias occur when the opening is in the middle or base of the
penis. Rarely, the opening is located in or behind the scrotum.

This condition may cause a downward curve of the penis during an erection. Erections are
common in infant boys.

Other symptoms include:

Abnormal spraying of urine

Having to sit down to urinate

Foreskin that makes the penis looks like it has a "hood"

. Diagnosis

Hypospadias is usually diagnosed during a physical examination after the baby is born.
Treatments

Treatment for hypospadias depends on the type of defect the boy has. Most cases of
hypospadias will need surgery to correct the defect.

NB Infants with hypospadias should not be circumcised.

The foreskin should be kept for use in later surgical repair.

In  most cases, surgery is done before the child starts school. Today, most urologists
recommend repair before the child is 18 months old. Surgery can be done as young as 4
months old. During the surgery, the penis is straightened and the opening is corrected using
tissue grafts from the foreskin. The repair may require several surgeries.

Prognosis.

Results after surgery are most often good. In some cases, more surgery is needed to correct
fistulas or a return of the abnormal penis curve.

Most males can have normal adult sex ual activity.