What is Hypospadias?

Hypospadias is the condition when the urethra opening (meatus) is ectopically located on the underside of the penis (far down in the scrotum), instead of  being at the tip of the penis. The urethra is a tube through which the urine coming from the bladder exits the body. Hypospadias is anatomically classified depending on the location of  the urethral meatus on the penile shaft:

  • Anterior  (meatus located at the outer segment of the shaft)
  • Middle  (meatus located at the middle segment of the shaft).
  • Posterior (meatus located at the inner segment of the shaft, towards the perineum).

What are the risk factors?

Risk factors related to hypospadias are:

  • Heredity. It seems that when there is family history with hypospadias, there is about 7% risk for its reccurrence.
  • In a few cases, it seems to be related to neonatal endocrine disorders.
  • When women become mothers either  too young or too old
  • When babies are born with very low body weight

How is Hypospadias diagnosed?

In the vast majority of children today, the diagnosis is set at birth. Diagnosis requires taking into account various parametres, such as:

  • position, width and shape of the urethra meatus
  • size of the penis
  • curvature of the penis

In addition, the position of the testes has to be evaluated, for in about 10% of children with hypospadias, there is concomitant cryptorchidism (undescended testes). Urination should also be monitored to exclude the case of any urethral stricture. The incidence of congenital anomalies in the bladder and kidneys in children with hypospadias does not differ from the the incidence in the general population.

How is Hypospadias treated?

Hypospadias is treated surgically, as long as there are specific indications. These indications are both functional and aesthetic.

Functional indications

  • Location of the urethral orifice on the penile shaft
  • Urethral stricture inhibiting urination
  • Penile curvature

Αesthetic indications

These are related to the psychology of both parents and the child, once s/he grows up, and with the outer appearance of the penis.

There is a variety of surgical procedures to treat the problem, with the aim of correcting the penile curvature and forming a urethra sufficient enough in size with its meatus transferred to the tip of the penis. From an aesthetic point of view, the effort is to make the penis look as normal as possible. The difficulty of surgery depends on the severity degree of hypospadias. Parents should be informed in detail, for complications may occur. The best age for the child to be operated is between 6 and 18 months of age, while in some cases there may be need for revision surgeries. When the penis is too small, hormonal  therapy in an initial phase may be helpful, so that it has some time to grow before undergoing surgical reconstruction.