Hypospadias is one of the more frequently seen congenital differences in boys. This page explains how it forms, when correction is usually timed, and what adults treated in early life sometimes still need.
During early pregnancy the tube that carries urine forms by folding and joining along the underside of the developing penis. In hypospadias that join is incomplete, so the opening ends up somewhere along the underside rather than at the tip. It may sit just below the tip, partway along the shaft, or much closer to the scrotum, and the position determines almost everything about how it is managed.
Two other features often travel with it. The foreskin is frequently incomplete, hooded over the upper surface rather than encircling, which is often what a parent notices first. And there may be a downward bend, called chordee, caused by tighter tissue along the underside. This combination is why hypospadias is described as a spectrum rather than as a single condition.
This is a developmental difference, not an injury and not a disease. It is one of the more commonly seen congenital differences in boys, it has well established surgical pathways, and outcomes for the milder positions are generally good. It is entirely distinct from urethral problems that appear later in life after infection, instrumentation or injury, which are assessed and treated in a quite different way.
The findings vary a great deal with the position of the opening. Milder positions may cause no practical difficulty at all, which is worth saying plainly to any worried parent.
An opening somewhere on the underside rather than at the tip
A foreskin that is incomplete and hooded over the upper surface
A downward bend of the shaft, more obvious with an erection
A stream that sprays or points downward rather than forward
A need to sit rather than stand to pass urine as a boy grows
In the milder positions, very little visible difference at all
In adults treated in early life, a stream that has gradually weakened
Frequently, no symptom whatsoever and an entirely ordinary adult life
Timing is planned rather than urgent. The decision depends on the position of the opening, the degree of bend and the amount of tissue available to work with.
This page explains hypospadias as a congenital condition and the pathways generally used for it. Correction in infancy is usually undertaken by paediatric surgical services rather than at a men's health clinic, and this page does not state that such an operation is performed here. Adults seeking review are assessed and referred where referral is the right answer.
Which of these applies depends on the position of the opening, on whether there is a bend, and on whether an operation has already been performed.
Where the opening sits very close to the tip, there is no bend and the stream is normal, an operation may not be needed at all. This is a legitimate outcome rather than a failure to treat.
Repair positions the opening at the tip and straightens any bend. It is usually undertaken by paediatric surgical teams and is timed around growth rather than around convenience.
Adults repaired as boys sometimes develop a narrowing, a small opening along the line of the repair, or a weakened stream. Each is assessed and treated as a problem in its own right.
Repair is possible after growth has finished but is more complex, and the honest goal is improved function and appearance rather than an unmarked result.
What parents and adults most often want to know about this condition.
Ask a QuestionIt happens when the tube along the underside does not finish closing during early pregnancy. In most cases no specific cause is ever identified. There is sometimes a family history, and certain hormonal factors have been studied, but parents should know that nothing they did or failed to do brought it about.
Most centres plan repair in the early years of life, once a boy is big enough for surgery and before he becomes aware of the difference. The exact timing is decided by the surgical team according to the position of the opening and the amount of tissue available to use.
Usually not before assessment. The foreskin tissue is often used during the repair, so removing it first can make the operation considerably harder. Anyone planning a circumcision for a boy with an unusually placed opening or a hooded foreskin should have him examined first.
Most people need nothing further. A minority develop a narrowing at the repair, a small opening along its line, or a stream that gradually weakens. These usually appear over years rather than suddenly, they are recognisable, and they are treatable once properly assessed.
The condition itself does not involve the testes, so hormone production and sperm production are usually unaffected. Where the opening sits very far back or a significant bend remains, delivery of semen can be affected, which is a mechanical issue and can be assessed directly.
Yes, although it is more involved than repair in early life and often needs staged surgery. Tissue is less forgiving once growth is complete and the chance of needing a second procedure is higher. The realistic aim is a straighter shaft and a better positioned opening rather than perfection.
Speak with Dr. Ashutosh Shah at Elegance Clinic, Surat.
