Hypospadias (Abnormal Urethral Opening)

Hypospadias

Hypospadias is a birth defect in boys in which the opening of the urethra is not located at the tip of the penis1. This irregular opening can form anywhere from just below the end of the penis (on the shaft), to the scrotum. This is a relatively common condition that occurs in approximately one out of every 250 boys2. This abnormality forms sometime between the eighth and fourteenth week of pregnancy. The three types of hypospadias depend on the location of the urethra opening.

·      Subcoronal: The opening of the urethra is located near the head of the penis (glans)

·      Midshaft: The opening of the urethra is located on the shaft of the penis

·      Penoscrotal: The opening of the urethra is located near where the penis and scrotum meet1

                                                                             

Not only is the urethral location in the atypical position in hypospadias, but the foreskin is often incompletely developed, resulting in the formation of a dorsal hood that leaves the tip of the penis exposed. Some males may have an abnormal foreskin with a normally positioned urethral opening and others might have a complete foreskin that hides an abnormal urethral opening. 

                                                                                            

Causes

As the penis develops in a male fetus, particular hormones stimulate the formation of the urethra and foreskin. Hypospadias results when there is a malfunction in the action of these hormones, causing the urethra to form abnormally3. Since hypospadias affects infants, the known causes of this condition link back to the physical state of the mother. There are several factors that influence the risk of a baby boy having hypospadias.

·      Having a mother over age 35 who is considered obese

·      Having a mother who utilized assisted reproductive technology (i.e. in vitro fertilization, zygote intrafallopian transfer, gamete intrafallopian transfer)

·      Having a mother who took hormones before or during pregnancy1

·      Having a father who has hypospadias (trait is sex-linked). Of fathers who have hypospadias, approximately 7% of their infant sons also have this trait.

·      Having a mother who was exposed to smoking3

Symptoms

Boys who have hypospadias sometimes have a downward-curved penis. They may also experience spraying during urination due to the misplacement of the urethral hole, but sitting down when urinating can help with this issue. Some boys with hypospadias have a testicle that has not fully descended into the scrotum (a result of further development problems in utero)1. If hypospadias goes untreated until adulthood, it can lead to erectile dysfunction3.

Treatments

Hypospadias can be “cured” by moving the urethral opening to the tip of the penis head. This can be accomplished with surgery, typically within the first 3-18 months of a boy’s life2. This surgery is often done in stages to attend to various issues such as placing the urethral opening in the right place, correcting the curve in the penis, and repairing the damaged skin around the opening of the urethra1. Since the doctor may use parts of the foreskin to make repairs, an infant with hypospadias should not be circumcised.

                                                          

 

1. "Facts about Hypospadias." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 16 Oct. 2014. Web. 21 Nov. 2014.

2. "Urology Care Foundation The Official Foundation of the American Urological Association." Urology Care Foundation. N.p., Mar. 2013. Web. 21 Nov. 2014.

3. "Hypospadias." Causes. Mayo Clinic, 1 Oct. 2013. Web. 21 Nov. 2014.

Last Updated: 03 12 2014

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