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Hypospadias

Hypospadias is one of the most common congenital defects. Its current incidence is estimated to be in the order of 1 case per 300 males in Italy.

This condition can vary in severity, but the precise cause remains unknown. Fortunately, hypospadias does not involve other defects in the urinary system or other organs, but if left untreated, it can cause significant problems in adulthood.

However, with corrective surgery, normal urination, sexual activity, and reproductive capacity can be restored.

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What is Hypospadias?

Hypospadias is a congenital condition affecting the urethra, the tube through which urine is excreted from the body. In males born with hypospadias, the opening of the urethra, called the urethral meatus, is in an abnormal location. Rather than being located at the tip of the penis, the meatus may be in different positions, such as under the end of the penis or even around the scrotum.

Causes of hypospadias

For most cases, the exact causes of hypospadias remain unknown. However, studies have indicated that both genetic and environmental factors may play a role in its manifestation.

  • Genetic factors:
    • If the father was born with hypospadias, the risk that the son will have it is about 12%.
    • If an older brother also has it, the probability increases to 21%.
  • Environmental factors:
    • Certain factors during pregnancy, such as diet, exposure to specific chemicals, or medications taken by the mother, could increase the risk of hypospadias.

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What Are the Signs and Symptoms of Hypospadias?

Some boys with mild forms of hypospadias have no symptoms at all. Symptoms may include:

  • Opening of the urethra is at a location other than the tip of the penis.
  • Downward curve of the penis (chordee).
  • Hooded appearance of the penis.
  • Abnormal or downward pointed urine stream.

Hypospadias types

The different types of hypospadias are based on the location of the opening of the urethra. Types of hypospadias include:

Distal hypospadias

This form includes:

  • Glanular – Occurs when the opening is lower than it should be but still on the head of the penis.
  • Coronal – Occurs when the opening is at the bottom of the head of the penis.
  • Subcoronal – Occurs when the opening is located somewhere near the head of the penis.
  • Midshaft – Occurs when the opening is located along the shaft of the penis, close to the middle of the shaft.

Proximal hypospadias

This form includes:

  • Proximal shaft – Occurs when the opening is located low on the shaft, but not yet at the level of the scrotum.
  • Penoscrotal – Occurs when the opening is located where the penis and scrotum meet.
  • Scrotal – Occurs when the opening is located anywhere on the front or bottom of the scrotum.
  • Perineal – Occurs when the opening is located in the area behind the scrotum and in front of the anus.

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How Do You Diagnose Hypospadias?

Hypospadias is generally diagnosed at the time of birth during a physical examination. The doctor may note the abnormal position of the urethral meatus, as well as any irregularities in the foreskin, such as a partially formed foreskin.

The first evaluation of the newborn with hypospadias takes place directly in the hospital. The neonatologist examines:

  • The severity of the penile anomaly.
  • The presence and normal descent of the testes into the scrotum.
  • Any abnormalities of the urinary tract or other organs, through specific screening tests.

If the child has undescended testes, a severe form of hypospadias, or abnormalities associated with other organs, genetic counseling may be necessary to further investigate the diagnosis and plan any treatments.

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How Do You Treat Hypospadias?

The correction of hypospadias is generally carried out through surgery, which involves:

  • Straightening the shaft.
  • Creating a new urinary channel.
  • Repositioning the urethral meatus to a position closer to the tip of the penis.

Often, the tissue from the foreskin is used to reconstruct the urinary channel, which is why circumcision is discouraged before the surgery.

The ideal age for the procedure is between 6 and 12 months, as younger children tend to have a quicker recovery and no memory of the surgery.

Recovery and possible complications

Most patients require a few days of recovery after surgery, during which a catheter may be placed to facilitate urination. Some may experience swelling and bruising, but this tends to subside within the first six weeks, and complete wound healing occurs within six months.

The most common complications include:

  • Fistulas (small holes in the penis that may cause urine leakage).
  • Scarring in the new urinary channel, which could obstruct urination.

Regular follow-up with the urologist is essential to monitor healing and intervene promptly in case of issues.

For a successful intervention

The success of the surgery depends on several factors:

  • The experience of the surgeon and the choice of the most suitable technique for the individual case.
  • The right timing for the surgery, based on the child's growth.
  • The use of advanced technologies, such as optical magnification tools and innovative materials for sutures and dressings.
  • Attention to the post-operative phase, with regular check-ups to reduce the risk of complications.

A key role is also played by the collaboration between parents and the surgeon: adequate information and a shared approach help ensure the best possible outcome and minimize the child's discomfort.

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Reviewed February 2025.