Overview

Advertising Disclaimer Hypospadias is a condition that is present at birth (congenital) in which the opening of the tube that carries urine and, in males, semen from the body (the urethra) is located below the normal location. This is caused by incomplete development of the urethra in utero between 8 and 20 weeks of gestation. Various degrees of hypospadias result in an opening located anywhere along the length of the urethra. Degrees of hypospadias are classified according to location, including anterior (50% of cases), middle (20% of cases), and posterior (30% of cases). Hypospadias may also cause a curvature of the penis (chordee). Chordee is sometimes evident only with an erection. Severe chordee may result in the inability to perform sexual intercourse. Without surgical correction, severe hypospadias may result in the inability to urinate standing and infertility. Incidence and Prevalence Hypospadias occurs in approximately 1 in 300 males and 1 in 500,000 females in the United States. Worldwide incidence is rising, partially due to an increase in the number of minor cases being reported. The condition is more common in infants of Jewish and Italian descent. Risk Factors and Causes The cause of hypospadias is unknown but may include genetic, endocrinological, and environmental factors. Genetic factors are suggested by an increase in the condition in twins compared to a single birth. Human chorionic gonadotropin (hCG) is a hormone produced in early pregnancy that stimulates the production of estrogen and progesterone. In the case of twins, the production of hCG may not be sufficient to prevent incomplete urethral development. There is also a 20% chance that an infant born with hypospadias has a family member with the condition. Endocrinological factors include low levels of androgens (e.g., testosterone, androsterone) and the infant's cells' inability to use these substances effectively may also result in hypospadias. Androgens are substances that stimulate the development of male characteristics. Maternal exposure to increased levels of progesterone, common during in vitro fertilization (IVF), increases the risk for hypospadias in the infant. Environmental exposure to estrogen during urethral development may also be a risk factor. Exposure can result when the mother ingests pesticides on fruits and vegetables and milk from pregnant cows. Signs and Symptoms Hypospadias results in a urethral opening located below the tip of the bulbous end of the penis (the glans penis). This opening may be located on the glans, along the shaft of the penis, at the pouch that contains the testicles (scrotum), or in the area between the scrotum and the anus

Surgical Complications Local swelling and minor bleeding are common following surgery to repair hypospadias and usually are not severe. A catheter is inserted into the bladder to drain urine.e. the urethra is extended using local tissue from the foreskin and the opening is repositioned at the tip of the glans. the penile skin is replaced and sutured. Mild hypospadias may not be diagnosed unless removal of the foreskin (circumcision) is performed. the more likely curvature in the penis (chordee) is present. Long-term complications that may require additional surgery include the following: . testosterone injections or creams may be used to increase penis size and antibiotics are administered to lower the risk for infection. If an adequate amount of tissue is not available. The penile skin is retracted and any curvature is corrected by removing the hardened tissue or pinching (plicating) tissue to offset the curvature. Other complications include upper urinary tract anomalies and backflow of urine from the ureter to the bladder (vesicoureteral reflux). Advertising Disclaimer Diagnosis Hypospadias is sometimes diagnosed by prenatal ultrasound. Finally. but it usually occurs in males at birth. Treatment Cases of hypospadias in which the urethral opening is near the tip of the glans do not require treatment if the urine stream is straight and there is no chordee. the foreskin is usually incomplete and the misplaced urethral opening is located. The farther the opening is from the tip of the glans. Then. Mild hypospadias results in a downward spray of the urine stream. the anatomy is thoroughly assessed. Moderate or severe hypospadias requires surgery to achieve the following: • • • • Allow the patient to urinate standing Correct curvature of the penis (chordee) Present a cosmetically acceptable appearance Preserve fertility Surgery is usually performed under general anesthesia when the child is between the ages of 6 and 18 months. Complications include adverse reactions to anesthesia and excessive bleeding that may require additional surgery.. Techniques vary considerably from case to case and may involve stages. Upon examination. Antibiotics are continued after the procedure and infection is rare. Before surgery. tissue from inside the mouth may be used. Common complications of severe hypospadias include undescended testicles and inguinal hernias (i. First. Diagnosis of hypospadias in females requires thorough physical examination. located in the groin).(perineum).

. Surgical correction for moderate or severe conditions is becoming increasingly successful. Inc.. All Rights Reserved.g.• • • Development of an abnormal opening from the urethra to the skin (fistula) Narrowing of the urethral opening (meatal stenosis) or the urethra (stricture) Formation of ballooning of the urethra (urethral diverticula) Prognosis The prognosis for hypospadias depends on the severity of the condition. tissue glue. urethral substitutes) and before birth (antenatal) intervention that may improve the prognosis are being developed.com. Surgical advancements (e. laser procedures. Prevention Hypospadias cannot be prevented. © 1998-2009 Healthcommunities.