A condition present from birth where the urinary opening sits on the underside of the penis rather than at the tip, often with a downward bend and an incomplete foreskin. Most cases are corrected in childhood, but adults do present too.
During development, the tube that carries urine forms by folding and fusing along the underside of the penis. In hypospadias that fusion stops short, so the opening ends somewhere along the underside instead of at the tip. How far short it stops decides the grade, from a mild variant just below the tip to a severe form near the scrotum.
Two other features often travel with it. The penis frequently curves downward because a band of tight tissue tethers the underside, and the foreskin is usually incomplete, forming a hood over the top with nothing underneath.
Mild forms may cause nothing more than a stream that points downward. More marked forms make standing to pass urine difficult, cause a bend that interferes with sex, and can affect the delivery of semen. Repair addresses all three aspects rather than the opening alone.
It is among the more frequent conditions present at birth in boys, and most cases are identified in the newborn period and repaired in early childhood. Milder forms are sometimes missed entirely and only come to light in adolescence or adulthood, often when a man notices the stream sprays or that the penis bends downward.
Adults also present after a childhood repair that has narrowed, developed a leak or left a curve, and these revision cases form a meaningful part of adult practice.
The features are anatomical rather than symptomatic, which is why mild cases can go unnoticed for years.
The cause is a partial interruption of normal development, and in most boys no specific reason is ever found.
Most cases are picked up in infancy. In adults, these are the situations that make assessment worthwhile.
Complete inability to pass urine, with a painfully full bladder, needs emergency hospital care. Fever with loin pain and burning on urination suggests a kidney infection and should be seen the same day rather than waiting.
Diagnosis is made on examination. The purpose of assessment is to grade it accurately and to plan a repair that addresses every element.
The exact position of the opening, the degree of curvature and the state of the foreskin are recorded. Grading drives everything that follows, including whether one operation will be enough.
The degree of downward bend is judged, since correcting it is a central part of the repair. Photographs of an erection taken at home are helpful and are handled confidentially.
Stream quality, bladder emptying and any history of urinary infection are reviewed. In adults presenting with fertility concerns, a semen analysis is arranged at this stage.
Deciding between a single stage and a staged repair, and identifying which tissue will be used for reconstruction. The plan, the risks and the recovery are set out before any date is fixed.
A successful repair moves the opening to the tip, straightens the shaft and gives a forward stream, so that standing to pass urine and normal intercourse both become straightforward. In children, results after modern techniques are generally excellent.
Adult repair is more demanding than childhood repair, particularly where previous surgery has left scarring, and it is sometimes staged across two operations. Where the foreskin is incomplete and reconstruction is not planned, circumcision surgery is sometimes used to tidy the hooded skin instead.
Cost depends on the grade and on whether previous surgery has been performed. A mild single stage repair is the least involved. Severe or revision cases need longer theatre time, sometimes tissue taken from elsewhere and occasionally two separate operations, and are quoted accordingly. Anaesthesia and any hospital stay are included in the single figure given after examination.
Repair is surgical and is tailored to the grade. There is no medicine that corrects the anatomy.
Where the opening sits just below the tip, the stream is forward and there is no bend, repair may add little. Some men reasonably choose to leave a very mild variant alone.
Ask about thisThe channel is extended to the tip, the shaft is straightened and the skin is reconstructed in one operation. Suitable for mild and moderate grades with healthy, unscarred tissue.
Ask about thisThe first operation straightens the shaft and lays down a graft, and the second builds the channel several months later. More predictable than forcing a difficult case into one sitting.
Ask about thisRelease of the tethering tissue on the underside, with additional straightening sutures or a graft where the bend is marked. Straightness is confirmed during the operation itself.
Ask about thisCorrection of narrowing, leaks, residual bend or a cosmetically poor result from childhood repair. Scarred tissue makes these cases more demanding and they are planned carefully.
Ask about thisHypospadias repair sits within our reconstructive genital surgery work. The pillar page below sets out the full range of foreskin, urethral and shaft procedures offered and how each is assessed.
Genital Surgery and AestheticsStraight answers about this concern, written for men in Surat.
Ask a QuestionYes. Adults are repaired regularly, both those never treated in childhood and those needing revision after an earlier operation. Adult tissue is less forgiving and scarring from previous surgery adds difficulty, so a staged approach is used more often than in childhood.
Sperm production is normal. What can be affected is delivery, because an opening low on the shaft may not deposit semen effectively during intercourse. Where that is the case, repair usually resolves it, and assisted techniques remain available if needed.
Foreskin tissue is often the best material available for reconstructing the urinary tube. Removing it before a repair is planned can take away the surgeon's preferred option, so routine removal is avoided until the reconstructive plan has been agreed.
Yes. Straightening the shaft is part of the operation rather than a separate procedure, because leaving a curve behind would defeat much of the purpose. The tethering tissue on the underside is released and the shaft is checked for straightness during surgery.
The two recognised problems are a narrowing of the new channel and a small leak where the repair has not fully sealed. Both are well described, both are usually correctable with a further procedure, and both are explained in detail before consent is given.
There is a familial tendency. It occurs more often in the sons and brothers of affected men than in the general population, although most cases arise with no family history at all. Genetic testing is reserved for cases with other developmental features.
In most men, yes. Erectile tissue itself is not abnormal in this condition. Once the shaft is straight and the opening is at the tip, sexual function is generally normal, and satisfaction after successful repair is high.
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