Hypospadias has emerged in recent years as one of the most common congenital malformations in newborn males. While its diagnosis can cause great concern for parents, it is a condition that, with proper evaluation and treatment, has an excellent prognosis.
In this article, you'll find everything you need to know about this condition. We'll explore its causes, the types of hypospadias available, and how to treat it.
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What is hypospadias?
Hypospadias is a birth defect in which the opening of the urethra (the urinary meatus) is not located at the tip of the penis, but on the underside of the penis, either at the glans, the shaft of the penis, the junction between the penis and the scrotum, or even the perineum.
This condition develops during pregnancy, between weeks 8 and 14, when the urethra does not close completely. It is also commonly accompanied by a downward curvature of the penis (chordee), which can complicate sexual function in adulthood if not corrected.
What types of hypospadias exist?
Hypospadias is classified according to the location of the urinary meatus, which determines its severity and the approach to treatment.
Distal or anterior hypospadias
This is the most common and mild form, occurring in approximately 70% of cases. Here, the urinary meatus is located near the head of the penis, either on the glans (subcoronal) or just below it. Penile curvature, if present, is usually minimal.
Medial or middle hypospadias
The urethral opening is located on the shaft of the penis. It accounts for approximately 10 to 15% of cases. It is usually associated with a moderate degree of penile curvature (chordee).
Proximal or posterior hypospadias
This is the most severe form, comprising only about 10% of cases. In this type, the meatus is located at the base of the penis, at the junction with the scrotum, or in the perineal area. There is almost always a significant curvature of the penis, and the scrotum may be abnormally shaped (bifid).
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Causes and risk factors
In most cases, the exact cause of hypospadias is unknown. It is believed to result from a combination of genetic and environmental factors that disrupt normal penile development during pregnancy.
Some of these identified risk factors include having a family history of hypospadias, which significantly increases the risk of this condition appearing in the child.
Some studies suggest a slightly higher risk in cases of advanced maternal age or in vitro fertilization. Maternal obesity has also been associated with an increased risk.
Exposure to hormones (such as estrogens or progestins) or endocrine disruptors, such as phthalates present in some plastics or pesticides during pregnancy can interfere with the normal hormonal development of the fetus, and can also lead to premature birth and low birth weight.
Symptoms and characteristics
The main visible sign is the abnormal location of the urethral orifice. Other associated signs and symptoms include chordee, a downward curvature of the penis, especially evident during an erection; a "hooded" appearance of the foreskin, which does not fully develop on the underside of the penis, giving the appearance of a hood, while the upper part is normal; abnormal spraying of urine, where the stream may be directed downward, making it difficult to urinate while standing; and, in severe cases, an ambiguous appearance of the genitals, which requires evaluation to rule out other disorders of sexual development.
Diagnosis and medical evaluation
The diagnosis of hypospadias is usually clinical and is made immediately after birth during the newborn's physical examination. The pediatrician or pediatric urologist will identify the position of the meatus, assess for curvature, and examine the condition of the foreskin and testicles.
Imaging tests are generally not required. However, in severe cases of proximal hypospadias where the testicles have not descended (cryptorchidism), studies may be ordered to rule out disorders of sexual development, such as a pelvic ultrasound or genetic testing.
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How is hypospadias corrected?
Hypospadias treatment is surgical and aims to correct both the position of the urinary meatus and the curvature of the penis, to achieve normal urination and sexual function, and an adequate aesthetic appearance.
The ideal time for surgery is usually between 6 and 18 months of age. At this age, the child tolerates anesthesia better, the tissue is malleable, and memory of the event is minimal.
There are more than 200 surgical techniques described, and the choice depends on the severity and type of hypospadias. The surgeon uses tissue from the foreskin or buccal mucosa to reconstruct the urethra and return the meatus to its correct position at the tip of the penis. Most surgeries are performed on an outpatient basis.
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What are the consequences of hypospadias?
With successful surgery, most men lead completely normal lives. However, some complications or after-effects may occur, especially in complex cases or multiple repairs. These include urethral fistula, which is a small abnormal opening along the reconstructed urethra that drains urine; meatal or urethral stenosis, which is a narrowing of the new opening or urethra, making it difficult for urine to pass; the development of a urethral diverticulum, which is a bulging or widening of the urethra that can cause urine to accumulate; and residual penile curvature, also called chordee; or cosmetic issues such as an unsatisfactory cosmetic result.
Many of these complications can be corrected with additional surgery.
Hypospadias prevention, is it possible?
There is no guaranteed way to prevent hypospadias, as it involves unpredictable genetic and environmental factors. However, general measures for a healthy pregnancy that may reduce the risk are recommended, such as folic acid supplementation at the doctor-recommended dose before and during pregnancy, avoiding exposure to endocrine disruptors by limiting contact with pesticides, tobacco smoke, and certain plastics, maintaining a healthy weight before and during pregnancy, and receiving adequate prenatal care, which is essential for managing any health condition.
Frequently Asked Questions (FAQs)
Is hypospadias hereditary?
Yes, there is a genetic component. Having a first-degree relative (such as a parent or sibling) with hypospadias increases a child's risk of developing it.
Does hypospadias affect size?
No, hypospadias itself does not affect the potential size of the penis. Corrective surgery is designed to preserve all erectile tissue and allow normal growth.
How common is hypospadias?
It is one of the most common birth defects in males. According to the CDC, it occurs in approximately 1 in every 200 to 250 male newborns, and its incidence appears to be increasing.
Does hypospadias affect fertility in adulthood?
Generally not, as long as it's corrected surgically. Severe, untreated cases can make it difficult for semen to enter the vagina during intercourse. Successful surgery allows for normal ejaculation. Fertility is usually normal if the testes and their function are normal.
What are the risks of hypospadias surgery?
The most common risks are the formation of a urethral fistula, a stricture (narrowing) of the urethra, a residual curvature of the penis, or a dehiscence (opening) of the wound. The success rate of primary surgery is high, exceeding 90% in distal cases.
How long does hypospadias recovery take?
Initial recovery takes 1 to 2 weeks. A urinary catheter is usually left in place for 5 to 14 days to drain urine and allow the urethra to heal. It is recommended to avoid rough activities or riding toys (such as tricycles) for about 3 to 4 weeks. Complete healing takes several months.
Specialized care from birth in Doctor T Clinic
Hypospadias is a congenital abnormality of the penis that can affect both urinary function and sexual development. Early detection and treatment are essential to prevent future complications.
En Doctor T Clinics We do not directly treat this type of pathologies, but if you are noticing chronic fatigue, lack of motivation, problems sleeping, or low libido, it is possible that the origin is a hormonal imbalance, such as a testosterone low.
We offer you tools to detect it early and, if necessary, initiate specialized medical treatment:
- Comprehensive health assessments focused on male wellness.
- Online Testosterone Test free, which acts as a first step in detecting hormonal problems.
- Personalized advice and treatments tailored to individual needs.
- Testicular health education and injury prevention methods.
- Testosterone Replacement Therapy (TRT), indicated in cases of primary hypogonadism o secondary hypogonadism, helps you regain your vitality, sexual energy and overall well-being.
Consult with our experts and improve your intimate health with clinical support!
Reservation your first medical consultation now
and discuss your case with one of our medical specialists, no strings attached.
Conclusion
Hypospadias is a treatable condition with an excellent surgical success rate. Early diagnosis and referral to a specialized pediatric urologist are crucial for planning correction at the optimal time.
The intervention not only aims to achieve a normal appearance, but also to restore urination and, in the long term, sexual function, allowing the child to develop a full and healthy adult life. Support and information for parents are fundamental pillars of this process.
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