Hypospadias is a relatively common congenital (present from birth) defect in which the opening of the urethra is on the underside, rather than at the end, of the penis.

See also: Epispadias

Hypospadias affects up to 3 in 1,000 newborn boys.

The condition varies in severity. In most cases, the opening of the urethra is located near the tip of the penis on the glans. More severe forms of hypospadias occur when the opening is at the midshaft or the base of the penis. Occasionally, the opening is located in or behind the scrotum.

The condition is often associated with a downward curvature of the penis during an erection. (Erections are common with infant boys.)

Some cases are passed down through families, while others result from unknown causes.

Symptoms include:

• Abnormal spraying of urine
• Downward curvature of the penis
• Having to sit down to urinate
• Malformed foreskin that makes the penis look "hooded"
• Urethra opening on the underside of the penis

A physical examination can diagnose this condition. Imaging tests may be needed to look for other congenital defects.

Infants with hypospadias should not be circumcised. The foreskin should be preserved for use in later surgical repair.

Surgery is usually completed before the child starts school. Today, most urologists recommend repair before 18 months of age. During the surgery, the penis is straightened and the hypospadias is corrected using tissue grafts from the foreskin. The repair may require multiple surgeries.

Results after surgery are typically good. In some cases, revision surgery is needed to correct fistulas and any return of the abnormal penis curvature.

If hypospadias is untreated, a boy may have difficulty with toilet training and problems with sexual intercourse in adulthood. Urethral strictures and fistulas may form throughout the boy's life, requiring surgical correction.

Typically a child is diagnosed with hypospadias shortly after birth. Call your health care provider if you notice that your son's urethral opening is abnormally located or that his penis becomes curved during erection.