Hypospadias is a congenital condition in which the male urethra’s urinary opening, known as the meatus, is not in the normal anatomical position at the end of the penis. It is the second most common inherited defect of the male geneto-urinary tract and occurs in about one in 250 male births, although worldwide, it is most likely significantly under-reported. 90% of cases are known as distal hypospadias and are found on or near the head of the penis, known as the glans. The remainder of the versions are proximal hypospadias and have the meatus near or within the scrotum. In most of the cases, there is a small amount of tissue extending to the tip of the glans from the meatus called the urethral plate. This plate helps typically to form the urinary channel in the anatomical condition.
The initial cause of Hypospadias is unknown. The condition is seen when the embryologic urinary channel fails to develop a tubular anatomical form, and the urethra does not develop normally.
The diagnosis is made most commonly in the newborn nursery by the characteristic appearance of the child’s penis. The urinary opening is lower than it should be and most affected children have an only partial development of the foreskin exposing the glans on its underside, known as a “hooded” foreskin. Untreated, children affected with hypospadias will have difficulty urinating, and as well as psychological and sexual dysfunction as they mature. Most children with hypospadias do not have other medical issues, however, occasionally a condition known as cryptorchidism occurs in combination with hypospadias. Cryptorchidism means that one of the boy’s testicles did not descend into the scrotum during embryologic development. When this happens in conjunction with hypospadias, further testing should be carried out to detect other potential diseases.
The treatment of hypospadias is directed at establishing a normal appearing penis that will also function normally. Achieving this goal requires surgery in most but not all patients. Reconstructive surgery involves straitening of the penis if necessary, placing the meatus or urinary opening in the correct anatomic position, and performing circumcision or reconstruction of the foreskin.
The timing of surgery can also be an important factor in achieving optimal results. Surgical repair can be carried out at three months of age and beyond. Premature babies should not have hypospadias repair considered before six months of age. Most of the procedures can be done on an outpatient basis unless they are a teenager or adult, and then it usually requires only a one-night stay in the hospital. Preoperative hormone therapy has been advocated by some to enhance the overall results of the surgery; however, subsequent studies have not supported this trend.
The most common method of reconstruction of distal hypospadias is the TIP (tubularized incised plate) repair, also known as the “Snodgrass” repair. It can be used for repair in most cases of distal hypospadias and is done by rolling the urethral plate from the abnormally low meatus to the tip of the glans penis.