Hypospadias

By Jeyashree Sundaram, MBA

Hypospadias is a congenital anomaly occurring in male children where the external urethral orifice is not located at the tip of the penis. The urethral opening in this condition is usually under the penis or at the scrotum.

Credit: Olena Yakobchuk/ Shutterstock.com

Hypospadias is quite a common malformation found in male infants (around 1 in 200) and does not cause any difficulty while nursing. Outpatient surgery is usually performed, which easily restores the basic appearance and functioning of the penis within six months. The treatment of hypospadias is generally successful, resulting in normal reproduction and urination in males.

Causes and symptoms

Although the specific cause of hypospadias is unidentified, it is believed that a few factors such as genes, hormones, and the environment are responsible for its development. As hypospadias is a congenital disorder, it occurs during fetal development; when the fetus is developing, the growth of the urethra is incomplete. Usually, an extra prepuse (foreskin) is formed on the glans and there is no prepuse on the fernum.

Hypospadias is not caused due to any parental action during pregnancy. In spite of the number of cases that have evolved from 1970, there is no specific cause identified for hypospadias. Researchers believe that it runs in families, i.e., a boy whose father has this abnormality will be more prone to hypospadias.  

In hypospadias, the urethral opening is located on the underside, inside, or in the middle of the penis. Rarely, it might also occur on the penis base or below the scrotum.

There are certain signs and symptoms for this malformation, such as:

  • Urinating in downward direction (children with severe hypospadias have to urinate by sitting down)
  • Penis may have a curve known as chordee
  • Penis with hooded appearance because there is an extra prepuse on the top
  • Glans region has abnormal appearance.

Hypospadias is found to have a higher risk in mothers with the following factors:

  • Pregnancy above the age of 35 years
  • Women who undergo fertility treatment for conception may get exposed to progesterone. This hormone is used in fertilization process and it has an elevated risk for hypospadias.
  • Pesticide exposure during pregnancy
  • Obesity
  • Smoking

Diagnosis

Hypospadias is rarely observed through ultrasound. Doctors generally diagnose this malformation during the first examination of the baby just after birth. The location of the urethral orifice decides the type of hypospadias in children: mild, moderate, or severe.

The mildest type of hypospadias is generally neglected, since it can be found by observing the children with absence of urethral opening at the tip of penis. Consulting the physician is better when the mild type hypospadias is determined. After diagnosis, the doctor refers children with hypospadias to the pediatric urologist.

Treatments and Follow-ups

Surgery may be recommended for treating hypospadias. The urologist generally treats hypospadias in a 1/2 or 1-year-old baby as the penile has had minimal growth. The main objective of performing this surgery is to correct the penis with an abnormal shape and to locate the urethral orifice in the correct position.

The male infant generally cannot undergo circumcision, as extra prepuse is required for surgical treatment. Surgical treatment is performed on an outpatient basis. Depending on the severity of hypospadias, additional surgeries might be required.

After surgery, the physician may prescribe a few medications for complete recovery of the child from hypospadias. Tylenol is used to avoid soreness during the initial stages of recovery. Antibiotic lotion is applied on the penis several times in a day. Antispasmodic drug is given to reduce bladder spasms.

Stents placed during surgery are removed after 7–10 days of follow-up appointment. For a few months the follow-up is continued to check the healing. The successful outcome of surgery can be expected within six months.

Complications

If hypospadias is not cured, the child may face a few problems after maturity:

  • Urination may be difficult to control and there might be multiple direction of urine spraying.
  • Curvature of penis may occur, leading to sexual dysfunction in the later stages of life.
  • Urethral orifice present behind or near the scrotum can cause fertility issues.
  • Swelling of urethral orifice can occur, which may prevent proper passing of urine.

Most complications can occur within the initial months following surgery. Problems occurring subsequent to surgery can be fixed, only after complete healing of tissues that have undergone operation for the first time (usually less than six months).

It is difficult to do multiple surgeries for this malformation, but more often the initial surgery is successful. The scarred tissues that are malignant in nature occurring from previous surgery can be removed and replaced with healthy tissue from other body parts (generally taken from cheek). This replacement with fresh tissue can work as the normal urinary channel.

Although there are up-to-date technologies for treating children with hypospadias, many researchers are developing clinical trials that provide great success in the diagnosis and treatment of this deformity. Clinical trials include research on hypospadias genetics to know about the cause and to help in identifying the malformation at the early stage. Various developing techniques have led to a high success rate for treatment of hypospadias.          

Sources:

Further Reading

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Last Updated: Aug 23, 2018

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