Hypospadias is a congenital abnormality of the penis which occurs in approximately 3/1,000 male infants. There appears to be a significant genetic element, with further male children having a risk of around 5-15%.

It is usually identified on the newborn baby check. If missed, parents may notice an abnormal urine stream.

Hypospadias is characterised by

• a ventral urethral meatus
• a hooded prepuce
• chordee (ventral curvature of the penis) in more severe forms
• the urethral meatus may open more proximally in the more severe variants. However, 75% of the openings are distally located.

Diagram showing the different variants of hypospadias. Credit: Centers for Disease Control and Prevention

Hypospadias most commonly occurs as an isolated disorder. However, associated conditions include cryptorchidism (present in 10%) and inguinal hernia.

Management

• once hypospadias has been identified, infants should be referred to specialist services
• corrective surgery is typically performed when the child is around 12 months of age
• it is essential that the child is not circumcised prior to the surgery as the foreskin may be used in the corrective procedure
• in boys with very distal disease, no treatment may be needed.