Hypospadias in Children

Overview

Hypospadias is a common congenital condition in which the opening of the urethra (the tube that carries urine out of the body) is not located at the tip of the penis. Instead, the urethral opening can be located anywhere along the underside of the penis, from just below the tip to as far back as the scrotum. This condition can affect urination and, later in life, may impact sexual function. Hypospadias is usually identified at birth, and it can vary in severity. Early diagnosis and surgical correction are important to ensure proper function and appearance of the penis.

Symptoms

The symptoms of hypospadias vary depending on the severity of the condition and the location of the urethral opening. Common signs and symptoms include:

  • Abnormal location of the urethral opening: The urethral opening may be located anywhere along the underside of the penis, rather than at the tip.
  • Downward curve of the penis (chordee): The penis may have a noticeable curve, especially during an erection, which can make urination and sexual function difficult.
  • Abnormal spraying of urine: Boys with hypospadias may have difficulty controlling the direction of their urine stream, leading to spraying or difficulty standing to urinate.
  • Incomplete foreskin: The foreskin may appear abnormal or incomplete, often with a “hooded” appearance, covering the top of the penis but not the bottom.

Types of Hypospadias:
Hypospadias is classified based on the location of the urethral opening:

  • Subcoronal: The urethral opening is located near the head of the penis, just below the tip.
  • Midshaft: The urethral opening is located along the shaft of the penis.
  • Penoscrotal: The urethral opening is located where the penis and scrotum meet, or even further back on the scrotum.

Causes

Hypospadias occurs during fetal development, when the urethra does not fully extend to the tip of the penis. The exact cause of this developmental issue is not fully understood, but it is believed to be related to a combination of genetic and environmental factors. Potential causes and risk factors include:

  • Genetic factors: A family history of hypospadias increases the likelihood of the condition occurring in future generations.
  • Hormonal influences: Abnormal levels of hormones during pregnancy, particularly those that influence male genital development, may contribute to hypospadias.
  • Environmental exposures: Some studies suggest that exposure to certain environmental factors or chemicals during pregnancy may increase the risk of hypospadias, though more research is needed.
  • Fertility treatments: Some studies have suggested that the use of fertility treatments, such as in vitro fertilization (IVF), may be associated with an increased risk of hypospadias.
  • Prematurity: Babies born prematurely or with low birth weight are at a greater risk for this condition.

Diagnosis

Hypospadias is typically diagnosed shortly after birth through a physical examination. In most cases, the abnormal placement of the urethral opening is visible during the newborn exam. Additional diagnostic tests are rarely necessary unless the condition is severe or associated with other congenital abnormalities.

Treatment Options

The treatment for hypospadias involves surgical correction to reposition the urethral opening and correct any curvature of the penis (chordee). Surgery is usually performed during infancy or early childhood to ensure normal urination and penile function later in life. At Gertrude’s Children’s Hospital, we offer expert surgical care for children with hypospadias.

  • Surgical repair:
    The goal of surgery is to move the urethral opening to the tip of the penis and, if necessary, straighten the penis. The surgery may also involve reconstructing the foreskin if desired. Surgical techniques include:

    • Urethroplasty: This procedure involves creating a new urethral opening at the tip of the penis and extending the urethra if needed. In more severe cases, tissue grafts may be used to lengthen the urethra.
    • Chordee repair: If the penis is curved (chordee), the surgeon will release or remove tissue causing the curvature to straighten the penis.
    • Foreskin reconstruction or circumcision: Some families choose to have the foreskin reconstructed during surgery, while others may opt for circumcision.
  • Postoperative care:
    After surgery, your child will need careful monitoring to ensure proper healing. A catheter may be temporarily placed to allow urine to flow while the surgical site heals. Pain management, antibiotics, and follow-up visits are essential parts of postoperative care.
  • Timing of surgery:
    Hypospadias surgery is typically performed between 6 and 18 months of age, as this timing allows for optimal healing and minimizes long-term complications. However, surgery can be performed later if the diagnosis is made at an older age.

Patient Success Stories

At Gertrude’s Children’s Hospital, we are committed to providing the best possible care for children with Hypospadias. Here’s why families trust us:

“Our child was diagnosed with Hypospadias, and we didn't know where to turn. The team at Gertrude's Children's Hospital was amazing - they worked with us to develop a personalized treatment plan that helped our child manage their symptoms and thrive.”

Emilyparent of a child with Hypospadias

Hypospadias in Children

Hypospadias is a relatively common congenital condition, affecting approximately 1 in 200 boys.

Surgery is typically performed between 6 and 18 months of age to ensure proper healing and minimize long-term complications. However, surgery can be done at a later age if necessary.

Most children with hypospadias require only one surgery. In some cases, additional procedures may be needed if complications arise or if the initial repair needs revision.

In severe cases where the urethral opening is located near the scrotum, hypospadias may affect fertility if left untreated. Surgical repair is essential to ensure normal penile function later in life.

Hypospadias is usually an isolated condition, but in rare cases, it may be associated with other congenital abnormalities. Your child’s doctor will perform a thorough evaluation to rule out any other issues.

Contact Us

If your child has been diagnosed with hypospadias, Gertrude’s Children’s Hospital is here to provide expert care. Our pediatric urology specialists will work with you to develop a personalized treatment plan to ensure your child’s health and well-being.

Contact us today to learn more about our Hypospadias in Children treatment options.

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