In hypospadias, the urine tube in a boy does not open at the tip of the penis, instead the opening is further down, sometimes at the root of the penis or between the testicles. There is often a bend of the penis called a chordee, and there is much more skin on the top than on the under-surface.
The exact cause is unknown but research suggests that the development of hypospadias may be hormone-related or genetic.
Hypospadias, in most cases, is obvious at birth and is diagnosed upon a physical examination.
Some of the mild cases may be missed. Other symptoms include abnormal spraying of urine and having to sit down to pass urine. Left untreated, hypospadias can lead to difficulty with toilet training, and problems with sexual intercourse as an adult. When diagnosed with hypospadias, the baby will be referred to a paediatric surgeon.
A repair of the urine tube is required usually between one and two years of age. If done before two years of age, the boy will learn to stand up and pass urine in a normal way.
In the operation, the tube is made to reach the tip of the penis, the curve is straightened out and the skin cover is refashioned. This is a complicated and meticulous operation. A urinary catheter (a soft drainage tube passed into the urinary bladder through the repaired urethra or urine tube) is needed to drain the urine for a period of time while healing occurs.
The results depend on how severe the condition was before surgery. The main complications are fistulas i.e. small areas of leakage which will need a second minor repair. For very severe cases, the repair may be done in stages.
Babies with hypospadias should not be circumcised as the foreskin is needed for use in later surgeries.
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