Put simply, hypospadias is a birth defect that occurs in male infants in which the opening for the urethra forms on the underside of the penis. In normal development, the opening forms in the tip of the penis, but a congenital condition causes the malformation that occurs in hypospadias. The urethra is responsible for draining the urine from the body, as it exits the bladder.
The Causes and Symptoms of Hypospadias
It’s currently unknown what the underlying cause of hypospadias is, though we do know that genetics play a factor. Additionally, environmental causes may increase the risk of developing the condition, but more research is needed in this area. If science can learn more about what factors instigate the condition, it may be possible in the future to prevent it from developing.
In a male fetus, the release of specific hormones stimulates the formation of the foreskin and urethra. Sometimes, a malfunction in this process causes the urethra to develop abnormally and the opening is formed in the wrong part of the penis. Therefore, the most obvious symptom of hypospadias is the abnormal development of the opening of the urethra. Instead of forming at the tip, it can form just below the head of the penis. In rare cases, it may form farther down the shaft or can even develop beneath the scrotum.
Additional symptoms may be observed in the infant, as he develops. For instance, the penis may take on an unusual curve, known as chordee. The foreskin may develop abnormally as well. In some cases, foreskin only covers the top portion of the penis, giving it a hooded appearance. There may also be a spray effect, during urination.
In most cases, hypospadias repair is possible through a surgical procedure and such surgeries have been used since the late 1800s. Historically, there have been over 200 types of surgical techniques used to correct hypospadias, though, today, just a few different techniques are used. The surgery is usually performed during infancy to give the corrected penis an opportunity to develop normally.
A pediatric urologist will perform the procedure with the goal of straightening the penis as much as possible, while also extending the urethra to the tip of the penis. If the surgeon can’t bring the urethra all the way to the tip, he will get it as close as possible.
The surgery requires a four-step procedure that involves straightening the shaft of the penis, forming the urinary tract, and opening a hole, or meatus, in the head of the penis. The fourth step involves performing reconstructive surgery on the foreskin, though, in some cases, it may be preferable to perform a circumcision instead. This will be a decision that the doctor and parents will make together.
In most cases, the entire procedure is done in a single day, taking anywhere from 90 minutes to over three hours. The procedure can take longer, if there’s a more severe case of chordee, because the surgeon needs to straighten the shaft, before he can make the urinary channel. Once completed, the procedure should be the only repair needed in the individual’s lifetime. As the body grows and develops through puberty, the corrected urinary tract should develop as well.