Hypospadias is a congenital defect in which the opening of the urethra is located on the under surface of penis, instead of at the end. In more severe forms of hypospadias the opening of the urethra is in the middle or at the base of the penis. Rarely, this opening is located in or behind the scrotum.
Due to this the hypospadias boys have to sit down and pass urine. If they stand and pass urine like normal boys, the urine is deviated downwards towards their feet.
As an adult, sexual activities become difficult due to the abnormal curvature of the penis during erection. They have much lower chance to have children, as they cannot deposit the sperm normally. The sperm leaks out through the opening located underneath.
The exact cause of hypospadias is unknown. It can be easily diagnosed at birth during routine physical examination.
Surgery usually restores the normal appearance of the child's penis. When the problem is corrected by 1-3 years of age with a good outcome, there should be no problem in future for fertility.
Causes of Hypospadias
The cause of hypospadias is often unknown. It is a congenital abnormality.
Sometimes, hypospadias is inherited. It is more common in infants with a family history of hypospadias.
During the development of the penis in a male fetus, certain hormones stimulate the formation of the urethra and foreskin. If there is a malfunction in the action of these hormones, the urethra develops abnormally. The urethra is formed by the fusion of the urethral folds along the ventral surface of the penis. Hypospadias occurs when there is incomplete closure of the urethral folds.
Symptoms and Diagnosis of Hypospadiasis
Symptoms of hypospadias depend on the severity of the condition. They include -
Abnormal spraying of urine
Having to sit down to urinate to avoid the urine from running down to the feet.
Hooded appearance of the penis as only the top half of the penis is covered with foreskin.
Chordee- Downward curve of the penis during an erection.
Most infants with hypospadias are diagnosed soon after birth during a physical examination.
Treatment of Hypospadias
Hypospadias can be corrected with surgery.
During surgery, the doctor uses tissue grafts from the foreskin or from the inside of the mouth to reconstruct the urethra in the proper position, correcting the hypospadias. If required the shaft of the penis is straightened and the excess foreskin is circumcised.
Most of the hypospadias belong to the mild variety and can be operated in a single stage operation. When the opening is too far down from the tip, it might require two-stage operation.
The operation is usually performed between 4-12 months of age. The earlier the surgery is done it is less traumatic for the child. However, the procedure can be completed at any age; even during adulthood.
By completing the operation before 2-3 years of age, these children can be toilet trained normally like any other child.