Hypospadias

Identifying and Treating This Male Genital Anomaly

By Donna Smith

The first thing most new parents do is count all of Baby's fingers and toes. However, not many would think to check their newborn son's penis for hypospadias, a condition that occurs in approximately one in 250 births.

"Hypospadias is a condition in which the end of the urethra (the tube in the penis that males urinate through) is not located at the tip of the penis," says Dr. Earl Cheng, attending physician in the Department of Urology at the Children's Memorial Hospital in Chicago, Ill. "The cause of this condition is not known and is usually an isolated congenital defect that is not associated with any other defects in other organs."

Hypospadias varies in severity from mild – opening near the glans of the penis – moderate – on the penile shaft – to severe – on the base of the penis or further back. In about two-thirds of all cases the defect is located near the end of the penis, where the opening is either in the glans (the "head" of the penis) or just below the glans on the underside. "In more severe forms of hypospadias, the opening is located further down on the penile shaft or in the scrotum," says Dr. Cheng.

How hypospadias will affect a child throughout life depends on the severity. "In the most severe cases, the patient may not be able to deliver sperm during coitus and have some minimal problems with urinating while standing up," says Dr. Hiep T. Nguyen, M.D., FAAP, pediatric urologist and assistant professor of urology and pediatrics at USCF Children's Hospital in San Francisco, Calif. "In the majority cases, it does not affect growth or development."

Hypospadias is also associated with a downward curvature of the penis. "This is known as 'chordee,'" says Dr. Cheng. "In general, the more severe the hypospadiac defect, the more severe the chordee."

"Usually, hypospadias is associated with an incomplete foreskin such that it is easily recognized when a newborn is examined," says Dr. Cheng. "However, in some cases, hypospadias can occur with a full foreskin and is only recognized at the time a circumcision is being performed or after the circumcision has been completed."

"It is very important during newborn [exams] for the physician to carefully evaluate the genitalia for congenital anomalies," says Dr. Nguyen. "Hypospadias can be one of the ... signs of a more severe medical condition known as congenital adrenal hyperplasia. This problem can be lethal if not appropriately diagnosed and differentiated from simple hypospadias."

Franci Newhouse's son, Evan, now 15 months old, was diagnosed with hypospadias about a week after his birth. "Over the past year we have had a lot of stress about the hypospadias," says the Plattsmouth, Neb., mother. "The first couple of months I sat at the computer crying every night reading stories and things about hypospadias. It's a big stress knowing that your decision can cause problems for your child for the rest of his life." After Evan's diagnosis, he was immediately scheduled to see a pediatric urologist.

Robin Schmidt from Springfield, Ill., found out immediately that her son, John, now 5 months old, had mild hypospadias. "In fact, as they pulled him out (C-section), he urinated, and the doctors said to each other, 'hypospadias,'" she says. "My OB/GYN was very familiar with the condition, as her son has it as well. Our pediatrician and the pediatric urologist examined him within 24 hours also."

"The parents should consult a pediatric urologist in order for their child to be fully evaluated and options for correction discussed," says Dr. Nguyen.

Want to see more?

• Making the Cut: Rethinking Newborn Circumcision
• The AAP's Circumcision Recommendations
• Newborn Circumcision: A Parent's Guide to Proper Care
• Talk about it!