Hypospadias is a congenital malformation of the male urethra in which the external urethral meatus opens on the underside of the penis rather than at its tip.
What is hypospadias?
Hypospadias is a congenital malformation of the male urethra in which the opening of the urethral meatus is located on the ventral surface of the penis rather than at its normal distal tip. This birth defect arises from incomplete fusion of the urethral folds during the first trimester of embryonic development, resulting not only in an ectopically placed urinary orifice but frequently in a ventral curvature or chordee. Occurring in approximately one in two hundred to three hundred live male births, hypospadias stands among the most frequent genitourinary anomalies. Clinical presentations vary according to the position of the meatus, ranging from distal glanular or coronal openings to more proximal penoscrotal or perineal locations that may compromise urinary function and sexual development. Diagnosis typically occurs at birth through careful genital examination, enabling prompt referral to a pediatric urologist for evaluation and surgical planning. Standard corrective surgery aims to reposition the meatus at the tip of the penis, straighten the shaft if chordee is present, and reconstruct the foreskin to achieve both functional and cosmetic normalcy, with most procedures performed between six and eighteen months of age. When addressed early, outcomes are excellent and long-term complications rare.
What are the types of hypospadias?
Hypospadias can be classified into several types based on the position of the urethral meatus along the ventral surface of the penis.
At the mild end of the spectrum, glanular hypospadias, accounting for roughly 50 percent of cases, features an ectopic opening on the glans tip and usually entails minimal curvature.
Next is coronal hypospadias, where the meatus lies just below the coronal sulcus, followed by distal penile hypospadias with the opening along the distal shaft; together these distal variants represent about 70 to 75 percent of diagnoses and often require straightforward surgical repair.
Midshaft hypospadias involves a meatus midway along the penile shaft, typically accompanied by mild chordee and making up approximately 20 percent of cases.
Proximal forms—penoscrotal, scrotal, and perineal hypospadias—are less common but more complex.
These proximal types often feature ventral curvature and may require staged repairs to restore both function and appearance. Surgical approach varies, with distal forms corrected in one operation and proximal cases requiring staged repairs to ensure optimal function and appearance.
How is hypospadias diagnosed & treated?
Diagnosis of hypospadias begins with careful physical examination of the newborn’s external genitalia, ideally performed shortly after birth. The clinician inspects the location of the urethral meatus along the ventral penile shaft, glans, or perineum, notes any ventral curvature (chordee), and evaluates the quality of the prepuce, looking for dorsal hooding. When the diagnosis is clear-cut in mild cases, no additional imaging is required; however, more proximal hypospadias may prompt renal and pelvic ultrasound to rule out associated renal tract anomalies. Following diagnosis, referral to a pediatric urologist or surgeon specializing in genital reconstruction allows for individualized surgical planning. Timing of repair typically falls between six and eighteen months of age to optimize tissue healing and psychological adaptation. Primary surgical techniques include tubularized incised-plate urethroplasty for distal defects and staged graft or flap procedures for severe proximal forms. Intraoperative assessment of chordee guides ventral corporoplasty or plication for shaft straightening. Postoperatively, catheterization is maintained for five to ten days, and prophylactic antibiotics reduce the risk of urinary tract infection. Follow-up extends into adolescence to monitor urinary function, cosmesis, and sexual development, with the majority of patients achieving continent, straight, and cosmetically acceptable outcomes. Genetic counseling may aid family planning.
Can hypospadias birth defect be prevented?
Hypospadias prevention remains challenging given its multifactorial origins combining genetic predisposition and environmental influences. Because key developmental processes occur early in the first trimester, primary prevention strategies must focus on optimizing maternal health prior to and during early pregnancy. Preconception counseling aimed at identifying family history of hypospadias or endocrine disorders can inform risk reduction measures. Women of childbearing age should avoid exposure to known endocrine disruptors, such as certain phthalates, pesticides, phenolic compounds, and unprescribed progestin medications. Achieving optimal glycemic control, maintaining healthy body weight, and managing chronic conditions like diabetes and hypertension reduce hormonal imbalances that may contribute to urethral fold malformation. Although folic acid supplementation is widely recommended for neural tube defect prevention, its role in hypospadias risk reduction remains inconclusive but may offer overall benefits for fetal development. Avoiding unnecessary use of assisted reproductive technologies and limiting paternal exposures to environmental toxins may further mitigate risk.
Conclusion
In conclusion, hypospadias is a common congenital urethral anomaly in boys, ranging from mild glanular forms to more complex proximal variants. Early diagnosis through newborn genital examination and referral to a pediatric urologist enable timely surgical correction—typically between six and eighteen months—that restores straight penile alignment, normal urinary function, and satisfactory appearance. While primary prevention remains limited by multifactorial causes, optimizing maternal health and minimizing exposure to endocrine disruptors during early pregnancy can modestly reduce risk. With modern techniques and ongoing follow-up, most affected boys go on to lead healthy, confident lives.
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