Hypospadias is an abnormality of the urethra and penis that is present at birth. This can cause problems with passing urine and also with erections. It can range in severity. Surgical correction is usually very successful.

The urethra is the tube that urine flows through out of the bladder. It passes through the penis. The opening of the urethra is normally at the end of the penis, partly covered by the foreskin.

The main problem is that the urethra opens on the underside of the penis instead of at the end of the penis. The opening can be anywhere from just below the normal position (mild) to as far back as the base of the scrotum (severe).

Hypospadias may also include the following:

• A hooded appearance of the foreskin. This is because the foreskin does not develop on the underside of the penis.
• Tightening of the tissues on the underside of the penis. This pulls the penis down and it cannot fully straighten. The further back the urethral opening is, the more severe the chordee tends to be. Mild hypospadias may not have any chordee.

What problems can hypospadias lead to?

Problems are likely to occur if hypospadias is left untreated. The further back the opening of the urethra is, the more severe the problems are likely to be.

• Passing urine is different to normal. A baby in nappies will have no problem. However, when older, the urine stream may not be able to be directed forward into a urinal. When going to the toilet the urine is likely to 'spray' backwards. Sitting on a toilet may be needed to pass urine without mess.
• Chordee which causes bending of the penis. This is more noticeable when the penis is erect. Sexual intercourse may be difficult or impossible in severe cases.
• Psychological problems about being 'different' to normal are common.
• Mild erection difficulties and premature ejaculation have been reported in adulthood in patients who have had surgery for hypospadias in childhood.

What are the causes of hypospadias?

The specific causes of hypospadias are unknown. However, there is a family trend: fathers and brothers of children with hypospadias are slightly more likely to have the abnormality.

Male and female genitalia are similar during the first eight or so weeks of development in the womb. The penis begins to develop after the eighth week. The defect in the urethra occurs between weeks 9 and 12 of pregnancy.

The reason why the penis does not develop properly is still not clear. The development of the penis whilst the baby is growing in the womb is partly dependent on the male sex hormones such as testosterone. The effects of testosterone on the growing penis may be blocked in some way.

Any tests needed to check hypospadias?

Hypospadias can be diagnosed with a physical examination when the baby is born. Because it is common, physicians check for hypospadias in all newborns.

The abnormality is easily noticed. Chordee, which often occurs at the same time as hypospadias, is not noticeable and may only be seen when the penis is erect.

The doctor may refer the family to a paediatric urologist to treat the baby.

What are the treatment options for hypospadias?

If the hypospadias is mild, with the opening of the urethra just a little down from normal and with no bending of the penis, then no treatment may be needed. However, in most cases an operation is required to correct hypospadias. This can normally be done in one operation. However, if hypospadias is more complicated, then two operations may be necessary. The operation is usually done when the child is around 4-18 months old.

Once surgery is completed, the baby may have a small catheter (tube) in order to pass urine. The catheter will stay in place for anywhere from a few days to two weeks. The doctor will also prescribe antibiotics to reduce the risk of any infection, as well as pain medications to help with any discomfort.

With modern technologies and techniques, hypospadias and chordee repair procedures are highly successful.