Male Genital Deformities: Hypospadias

Congenital defects or deformities of the urogenital tract may affect any portion of the male or female tract, including the male penis. One commonly seen congenital defect directly involves the way a man urinates, as well as the genital appearance: hypospadias.

What is Hypospadias?

Hypospadias (hi-poe-SPAY-dee-us) is a birth defect of the urethra in men, that involves an abnormally placed urinary orifice. In a hypospadic patient the urinary meatus (urinary opening), instead of opening at the tip of the of the penis, opens anywhere along a line (the urethral groove) running from the tip along the underside (ventral aspect) of the shaft to the junction of the penis and scrotum, or even lower in the space between scrotum and anus (perineum). An abnormally foreskin and downward bending of the penis (chordee) is an indicator of hypospadias in a male neonate patient.

The majority of cases have been seen with distal hypospadiasis (with the opening of urethra around the glans penis); these are categorized first degree hypospadias, and are 50-70% of cases. When the urethral orifice is located on the shaft of penis, it will be second degree, and when it opens below the scrotum or in perineum, it is third degree. The more advanced cases usually are associated with chordee, or associated with undescended testicle(s).

In these patients, the bending of the penis causes the urine stream to deviate (downward stream), and the more advanced deformity the more deviation of urine stream. Also due to the bending of the penis, patients with this deformity usually suffer from infertility and other severe problems in sexual intercourse.

Mild hypospadias is usually an isolated deformity of the penis. More severe cases of hypospadias may be accompanied by other deformities of the urogenital tact and may require a more extensive medical work up and diagnosis.

Hypospadias Treatment

Treatment of this abnormality requires surgical procedures, and consist of straightening of penis (ortoplasty), and moving urethral meatus to the tip of the penis (urethraplasty).  Since hypospadias is diagnosed shortly after birth, surgery is being recommended to be performed in a very young infant age and usually before the child starts school. Today, most urologists recommend repair before the child is 18 months old. Surgery can be done as young as 4 months old. During the surgery, the penis is straightened and the opening is corrected using tissue grafts from the foreskin. The repair may require multiple surgeries.

If your child or someone who you know is suffering from Hypospadias, please feel free to contact Dr. Elist's office for consultation, diagnosis, and possible treatment.