If your newborn is diagnosed with hypospadias

March 11, 2014 Beth Andersen, MD, FAAP

As a pediatric urologist, I am frequently asked to consult with parents whose newborn son has hypospadias.  

Hypospadias is usually diagnosed during the physical exam right after the baby is born.  When parents see the abnormal penile anatomy they naturally want to learn about the diagnosis and understand what, if anything, needs to be done. Answering these questions, discussing options, and performing reconstructive surgery to help restore normal penis appearance and function are some of the most rewarding things I do as a pediatric urologist. 

I would like parents who have a son born with hypospadias to be reassured that the anatomy can be reconstructed, the surgery is well tolerated, and a good outcome with a normal, or near normal, penis appearance and function can be achieved.

It is not urgent to treat newborns with hypospadias because they can usually pee (urinate) just fine through their existing urinary opening.

In fact, when hypospadias is the only condition noted in a newborn physical exam there is a low chance of additional developmental abnormalities. Additional tests and studies on the baby are usually not necessary.

It is important to note that if any unusual shape of the penis or urethral opening (where the pee comes out) is present then circumcision (if desired) should not be performed until after the child is examined by a pediatric urologist. This is because the pediatric urologist may need to use the foreskin tissue for the surgical repair. 

Here are answers to some commonly asked questions:  

What is hypospadias?

Hypospadias is a birth defect affecting approximately one out of every 250 male births.  Hypospadias occurs during development if the urethral channel, which passes urine from the bladder to the outside of the body, does not develop fully to the tip of the penis.  In boys born with hypospadias, this opening is lower than normal and may be located along the underside of the penis. 

What are the types of hypospadias?

The type of hypospadias depends on the location of the urethral opening.  In distal cases, the opening is near the penis head, in midshaft cases it is near the middle of the penile shaft, in proximal cases it is near the base of the penis or even behind the scrotum.

Many boys with hypospadias also have a curved penis and asymmetric foreskin.  The foreskin is often not completely developed and the penis head is partially exposed. 

What causes hypospadias?  
Hypospadias occurs between 8-14 weeks of pregnancy when the urethral channel is forming.  

Normal penile and urethral channel development depends on a number of factors and is very sensitive to hormone levels.  The use of certain hormones just prior to and during pregnancy has been associated with increased incidence of hypospadias.  Babies whose father and/or brother had hypospadias also have an increased chance of having hypospadias. 

For most newborns, the cause of the hypospadias is not known. 
What is the usual treatment for hypospadias?  

Parents of a boy diagnosed with hypospadias should arrange to have their son examined by a pediatric urologist.  Pediatric urologists have specialized training in evaluating hypospadias and can perform corrective surgery when needed.

What should I expect if hypospadias surgery is recommended? 
The location and type of hypospadias will determine whether or not surgical treatment is recommended.  Most boys with hypospadias do require surgery to allow them to pee straight and have a straight erection.

If surgery is needed, it is usually performed as an outpatient procedure by the pediatric urologist when the baby is between 6 to 12 months old.  General anesthesia is used to keep the baby asleep during surgery and additional medications provide post-operative pain relief.  The baby will usually go home the same day.  Hypospadias surgery is safe and well tolerated.

The anatomy of most boys with hypospadias can be fully reconstructed with one outpatient surgery.  Sometimes additional surgeries are necessary.  

Surgical repairs may include:

  • Correcting the curve of the penis

  • Building the urethral channel and moving the opening of the urethra to the right place

  • Repairing the skin around the opening of the urethra

  • Performing circumcision or reconstructing the foreskin to achieve an uncircumcised appearance

Modern surgical reconstruction techniques allow most boys with hypospadias to have excellent appearance and function.

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