Hypospadias

Overview

Hypospadias is a congenital condition, meaning it is present at birth, in which the opening of the urethra is not located at the tip of the penis. The urethra is the tube that carries urine from the bladder to the outside of the body. In hypospadias, the opening may be found on the underside of the penis, near the head, along the shaft, or, less commonly, closer to the scrotum.

Hypospadias can vary from mild to more complex. Some boys have a penis that curves downward, especially during erection, which is called chordee. The foreskin may also appear incomplete, with more skin on the top side of the penis and less on the underside. The condition is usually identified during a newborn examination.

Hypospadias is a treatable urological condition. Management depends on the position of the urethral opening, the degree of curvature, and the child’s overall health. A pediatric urologist can assess the condition and discuss appropriate options with the family.

Symptoms

The signs of hypospadias are usually visible at birth. They may include:

• The urethral opening being located on the underside of the penis rather than at the tip
• A downward curve of the penis
• An uneven or hooded appearance of the foreskin
• Urine spraying or not passing in a straight stream
• In more severe cases, difficulty directing the urine stream while standing

Hypospadias usually does not cause pain in newborns. However, if the condition is left untreated in moderate or severe cases, it may later affect urination, sexual function, or appearance. The impact varies depending on the severity of the condition.

Causes and Risk Factors

Hypospadias develops during fetal growth when the urethra and tissues of the penis do not form in the usual way. The exact reason is often not known. In many cases, there is no clear cause and nothing the parents did or did not do to cause the condition.

Several factors may be associated with a higher chance of hypospadias, including:

• A family history of hypospadias or other genital development differences
• Premature birth or low birth weight
• Hormonal or genetic factors that affect genital development before birth
• Certain maternal health or pregnancy-related factors

Most cases occur as an isolated condition, meaning the child is otherwise healthy. In some complex cases, especially when hypospadias is severe or accompanied by undescended testicles or other genital differences, further evaluation may be recommended to check for associated conditions.

Diagnosis

Hypospadias is most often diagnosed during a physical examination shortly after birth. A healthcare professional checks the position of the urethral opening, the appearance of the foreskin, and whether there is penile curvature. The testicles are also examined to ensure they are in the scrotum.

For mild cases, a physical examination may be enough to plan care. In more complex cases, the child may be referred to a pediatric urologist for detailed assessment. Additional tests are not always needed, but they may be considered if there are other findings, such as undescended testicles, ambiguous genital appearance, or concerns about urinary or reproductive anatomy.

Parents are often advised not to proceed with circumcision before specialist evaluation, because the foreskin may be useful during surgical repair if treatment is needed.

Treatment Options

Treatment depends on the severity of hypospadias and the individual child’s needs. Very mild cases may not require surgery if urination is normal, there is no significant curvature, and future function is not expected to be affected. However, many cases are managed with surgical repair.

The goals of treatment may include placing the urethral opening closer to the tip of the penis, correcting curvature, improving the direction of the urine stream, and achieving a typical appearance. Surgery is usually performed by a pediatric urologist. The timing is decided by the specialist together with the family, taking into account the child’s health, development, and the complexity of the condition.

Some children need one operation, while more complex cases may require staged procedures. As with any surgery, there can be risks, such as bleeding, infection, narrowing of the repaired urethra, or an abnormal connection that may require further treatment. The care team will explain the expected benefits, possible risks, and follow-up plan before any procedure.

Follow-up after treatment is important to monitor healing, urination, penile growth, and long-term function. Children may need periodic check-ups as they grow, especially around toilet training and puberty.

When to See a Doctor

Parents should seek medical evaluation if a newborn’s urethral opening does not appear to be at the tip of the penis, the foreskin looks incomplete or uneven, or the penis seems curved. A pediatrician can provide an initial assessment and refer the child to a pediatric urologist if needed.

Medical advice is also important if a child has difficulty urinating, a weak or spraying urine stream, repeated urinary concerns, or any swelling, redness, or discomfort in the genital area. If hypospadias is suspected, families should avoid making decisions about circumcision until the child has been evaluated by a specialist.

Early assessment helps families understand the condition, possible treatment options, and the most appropriate timing for care. With specialist guidance, most children can receive a care plan tailored to their anatomy and overall health.