Hypospadias is a congenital condition in which the urethral opening lies along the underside of the penis rather than at its tip. It affects roughly 1 in 200–300 newborn boys and often involves penile curvature (chordee) and an altered urinary stream, with surgical repair typically performed before age two.
Hypospadias is a common congenital anomaly in which the urethral opening forms on the underside of the penis rather than at its tip. Its severity ranges from a mild glandular variant—where the meatus is just below the glans—to more proximal forms at the penile shaft or penoscrotal junction.
Hypospadias is a frequent congenital malformation in which the urethral meatus opens anywhere along the ventral surface of the penis rather than at its tip. Occurring in approximately 1 in 200–300 live male births; it results from incomplete fusion of the urethral folds during the embryonic period. The spectrum ranges from distal or glandular hypospadias—where the meatus lies just below the glans—to midshaft and proximal variants at the penile shaft or penoscrotal junction. Nearly all cases display a dorsal hooded foreskin and some degree of ventral curvature (chordee), which may impede the stream of urine and complicate sexual function later in life. Associated anomalies, such as undescended testes or inguinal hernia, are reported in up to 10–15% of patients, underscoring the need for thorough evaluation after birth. Definitive treatment involves surgical reconstruction—typically between 6 and 18 months of age—aiming to relocate the urethral opening, straighten the shaft and create a circumferential foreskin or glans configuration. Advances in single‐stage tubularized incised plate (TIP) urethroplasty and dorsal plication techniques have raised success rates above 85%, with most boys achieving normal voiding and satisfactory cosmetic outcomes.
Hypospadias is classified by the position of the ectopic urethral meatus along the ventral shaft, with four main types reflecting increasing severity.
In glandular hypospadias, the mildest form, the opening lies on the glans or just below its corona; the foreskin typically forms a dorsal hood but leaves the ventral gland uncovered.
Coronal hypospadias positions the meatus at the coronal margin or just behind it, still sparing most penile shaft length but often accompanied by a downward curvature (chordee).
Midshaft hypospadias, occurring in roughly 10–20 percent of cases, has the opening along the penile shaft and frequently presents with more pronounced ventral curvature and ventrally deficient skin.
Penoscrotal hypospadias places the meatus at the junction of the penis and scrotum, with chordee severe enough to require more complex straightening and urethral reconstruction.
The rarest, perineal hypospadias, opens in the perineum—often in conjunction with other anomalies such as bifid scrotum or undescended testes—and usually signals underlying differences in sex development.
While distal (glandular and coronal) variants can often be corrected with less invasive, single-stage tubularized incised plate urethroplasty, proximal forms (midshaft, penoscrotal, perineal) may require multi-stage repairs, grafts, or flap techniques to achieve a functional, straightened penis with a cosmetically acceptable meatus at the glans tip.
Caring for a baby diagnosed with hypospadias involves gentle diapering, meticulous hygiene, and careful monitoring before and after surgical repair. Initially, parents should avoid circumcision, as foreskin tissue may be needed for reconstructive procedures; instead, the diaper area must be kept clean and dry with frequent changes to minimize moisture around the ventral penile opening. Soft, non-adhesive diapers or specialized pediatric briefs can cushion the area and reduce friction. Bathing should involve warm water only, without harsh soaps, gently patting dry. After corrective surgery—typically performed between 6 and 18 months—parents must follow the surgeon’s wound care instructions meticulously: applying prescribed antibiotic ointment, maintaining a sterile dressing, and preventing the diaper from rubbing against the surgical site. Pain management with pediatric dosages of acetaminophen helps soothe discomfort. Parents should watch for signs of infection—fever, redness, swelling, or purulent discharge—and contact the healthcare provider promptly. Limiting activity and positioning during sleep, often with the legs gently parted, can protect the repair. Scheduled follow-up visits ensure proper healing and urinary function.
Hypospadias most often announces itself at birth through a trio of unmistakable signs. First, the urethral opening—the meatus—resides anywhere along the underside of the penis instead of at its tip, ranging from just below the glans (glandular or coronal hypospadias) to the midshaft, penoscrotal junction or even the perineum in severe cases. Second, the foreskin assumes a characteristic dorsal hood configuration, leaving the ventral aspect of the glans uncovered. Third, many boys exhibit ventral penile curvature, or chordee, which becomes apparent during an erection or when the penis is gently stretched. Together, these anomalies can alter the urinary stream, causing it to spray, deflect downward or require sitting rather than standing to avoid soiling clothes. In proximal forms, a bifid scrotum may accompany the misplaced meatus, and associated findings such as undescended testes or inguinal hernia emerge in up to 15 percent of patients. While mild glandular variants may escape immediate notice, more pronounced presentations prompt early pediatric urology referral. Although hypospadias itself does not cause pain, the abnormal stream and curvature can lead to social embarrassment, difficulty with hygiene and, if uncorrected, potential challenges with sexual function later in life—making timely recognition and management essential.
Hypospadias arises from incomplete fusion of the urethral folds and ventral penile skin during the androgen-dependent window of 8 to 14 weeks of gestation. This process relies on placental transfer of maternal hCG, testicular testosterone synthesis, 5α-reductase conversion to dihydrotestosterone (DHT), and intact androgen receptor signaling. Disruption at any step—due to genetic variants in SRD5A2, AR, or embryonic patterning genes such as HOXA13—can impair urethral tube formation and result in aberrant placement of the meatus along the penile shaft. Familial predisposition doubles the baseline risk, while environmental exposures to endocrine-disrupting compounds like phthalates, bisphenol A, and pesticides have been linked to higher rates of hypospadias in studies. Maternal factors including advanced age, diabetes, obesity, and assisted reproduction may alter hormonal milieu or placental function, modulating risk. Low birth weight and prematurity correlate with increased incidence, underscoring the sensitivity of genital development to stressors. Epigenetic modifications may mediate gene–environment interplay. Although most cases occur in isolation, up to 15% present with associated anomalies—cryptorchidism, inguinal hernia, or DSD—reflecting broader disturbances in fetal urogenital morphogenesis. The multifactorial etiology of hypospadias encompasses polygenic inheritance, endocrine signaling defects, and environmental insults, culminating in a spectrum of phenotypes from mild distal forms to severe penoscrotal variants.
Definitive treatment of hypospadias is surgical, aiming to relocate the urethral meatus to the glans tip, straighten any penile curvature, and reconstruct a cosmetically normal foreskin or glans. Procedures are ideally performed between 6 and 18 months of age to take advantage of rapid healing and minimize psychological impact. Distal variants often respond well to single-stage techniques—most commonly the tubularized incised plate (TIP) urethroplasty—where the native urethral plate is tubularized after a midline incision to widen it, with minimal donor tissue required.
Proximal forms with significant chordee may demand multi-stage repairs: the first stage corrects curvature using dorsal plication or ventral grafts, while the second stage tubularizes the neourethra using buccal mucosa or inner preputial flaps. Intraoperative magnification and fine absorbable sutures reduce fistula and stricture rates. A small catheter remains in situ for 5–10 days to divert urine and protect the repair. Postoperatively, parents follow strict wound care, monitor for infection or leakage, and attend scheduled ultrasounds or uroflowmetry to assess urinary stream. Long-term follow-up into adolescence evaluates cosmetic outcomes, urinary function, and psychosexual adjustment. With modern surgical refinements, success rates exceed 85%, complications are uncommon, and most boys go on to achieve normal voiding, sexual function, and body image.
Equipped hospitals, and advanced specialized centers with experienced doctors and specialists are available in all medical treatment areas in Iran. Also, good hotels and entertainment centers have made Iran an appropriate choice for patients who need Hypospadias Treatment.
In Iran, hypospadias repair typically costs around 700-1,200 USD, which includes surgeon fees, anesthesia, operating‐room charges and a brief inpatient stay.
Hypospadias is a congenital condition in boys where the urethral opening is located on the underside of the penis instead of at its tip.
The condition stems from incomplete fusion of the urethral folds between 8–14 weeks of gestation, driven by androgen signaling.
Definitive management is surgical repair—ideally between 6–18 months of age—with techniques tailored to the meatus position and curvature.