Hypospadias: Causes, Symptoms, and Treatment
What is Hypospadias?
Hypospadias is a congenital condition, meaning a baby is born with it. Here, the opening of the urethra appears on the underside of the penis rather than at the tip. The urethra is the tube that carries urine from the bladder out of the body. In normal development, the urethral opening should be located at the head of the penis. This developmental anomaly occurs during fetal development. That means when the baby’s urinary system and penis are forming in the womb. What happens is that the tissues that form the urethra do not develop as they should.
What are the Different Types of Hypospadias?
Healthcare providers define hypospadias types based on where the urethral opening is:
- Coronal Hypospadias: This is the most common type of hypospadias. Here, the opening is just below the head of the penis. It may also be where the head meets the shaft. (The shaft is the long part of the penis below the head.)
- Midshaft Hypospadias: The opening of the urethra is located halfway along the shaft of the penis.
- Scrotal or Perineal Hypospadias: These are the most severe forms. In this case, the opening is on or below the scrotum. The sac of skin that holds the testicles is called the scrotum.
- Penoscrotal Hypospadias: The opening is where the penis meets the scrotum. In some boys, it may extend further down from the penis to the scrotum.
- Glanular (Balanic) Hypospadias: In this type, the opening is in the head of the penis. However, not at the very tip. This is the mildest type.
Penoscrotal and scrotal are called proximal types. In proximal hypospadias, the opening is close to or on the scrotum.
What are the Symptoms of Hypospadias?
Common hypospadias signs and symptoms include:
- The urethral opening is not at the tip of the penis. It may appear lower on the shaft of the penis or near the scrotum.
- The penis may bend downward (particularly during an erection). This curve of the penis is called chordee.
- In this condition, the foreskin often looks like a hood. It may only cover the top part of the penis. This is because the foreskin may not have fully developed.
- One of the symptoms of hypospadias is that the urine stream may spray in different directions. Therefore, many boys with hypospadias find it hard to aim their urine properly.
What Causes Hypospadias?
What causes hypospadias is still not fully understood. But research shows it results from both genetic and environmental influences. Some common causes and risk factors include:
- Having a family history of hypospadias can increase the risk. If your father or a brother has had hypospadias, the risk is higher for you.
- Mothers over 35 years old may have a higher chance of having babies with hypospadias.
- Hormonal imbalances during pregnancy can affect urethral development.
- Exposure to certain medications or chemicals during pregnancy may contribute. These harmful substances could include pesticides or hormones.
- Babies born with low birth weight or prematurely are more likely to have hypospadias.
- Specific genetic factors that affect the formation of the urethra can also contribute to hypospadias.
What is the Diagnosis for Hypospadias?
Pediatric urologists usually spot hypospadias during routine checkups of newborn babies. This is done by simply looking at the baby’s genitals. Since the urethral opening is in an unusual position, it usually makes the diagnosis straightforward. The doctor judges how severe the condition is by the following factors.
First, exactly where the opening is located, and second, whether the penis curves at all. Most of the time, no special tests or scans are needed. However, they may be required if the anatomy is particularly complicated.
Management and Treatment Options
Hypospadias repair can fix different levels of severity. There are several ways to treat hypospadias, including both surgical and non-surgical options:
- Surgical correction: Hypospadias surgery is the main way to treat hypospadias. This surgery is usually performed when a baby is between 6 and 18 months old.
- Single-stage repair: For most cases, only one surgery, called a single-stage repair, is needed. During this procedure, the doctor moves the urethral opening to the tip of the penis.
- Staged procedures: If the hypospadias is more severe, it might require several operations, called staged procedures. These surgeries are usually spaced out over several months.
- Chordee correction: The surgeon will also correct any penile curvature (chordee) during the same operation.
- Foreskin reconstruction: Surgeons can use plastic surgery techniques to make the foreskin look normal again.
- Pre-operative hormone therapy: In some cases, doctors might use hormone therapy with testosterone before the surgery. This can help increase the size of the penis, which can make the operation easier.
Complications
While it is generally safe, some risks of hypospadias surgery can occur:
- There is a chance of having a bad reaction to the anaesthesia used during the procedure.
- The surgical area could get an infection if it is not kept clean after the operation.
- You might experience some bleeding during or right after the surgery.
- Another risk of hypospadias is that sometimes the skin does not heal perfectly. This can lead to scarring or abnormal healing.
- A small hole might form between the new urethra and the skin. It is called a urethrocutaneous fistula. This can cause urine to leak out of a new spot.
- In severe cases, the condition can lead to problems with sexual function later in life. This may include issues with erections or ejaculation. It especially happens when the urethral opening is near the scrotum.
Fertility Assessment may be suggested to check if the condition has affected reproductive health. Hypospadias can be one of the male infertility causes and treatments may be needed.
FAQs
It is not usually life-threatening, but it can cause problems if it is not treated. Luckily, most cases can be treated with surgery.
Hypospadias is relatively common. It affects about 1 in every 200 baby boys.
No, they are different. Hypospadias is about the position of the urethral opening. Chordee is when the penis curves downward.
Yes, many men with repaired hypospadias can have children. However, if the condition is severe and not treated, it can sometimes affect fertility.
Yes. However, the urine may spray or go in different directions. This depends on where the opening is.
It can run in families, so genes from either parent might play a role. But it is not just about genetics; other things, like environmental factors, also matter.
In hypospadias, the urethral opening is on the underside of the penis. In epispadias, it is on the top.