Hypospadias in Children: A Clear Guide for Parents
Hypospadias is a common congenital condition in boys where the opening of the urethra is not located at the tip of the penis, but somewhere along the undersurface instead.
Where Can the Urethral Opening Be?
The opening can occur at different places along the underside of the penis:
- Glanular – near the head (mildest, most common)
- Coronal or subcoronal – just below the head
- Midshaft – along the penile shaft
- Penoscrotal – where the penis meets the scrotum
- Perineal – between scrotum and anus (most severe)
Other Associated Features
- Chordee: A downward curve of the penis, especially during erection
- Incomplete foreskin: “Hooded” appearance; foreskin may be missing on the underside
- Spraying or deflected urine stream
- Difficulty aiming urine while standing
Causes
- Not fully understood
- Likely due to hormonal or genetic factors during fetal development
- Sometimes associated with family history
Diagnosis
- Usually identified at birth during the newborn exam
- No special tests are needed for mild cases
- More severe cases may require imaging to check for other urogenital abnormalities
When to Visit the Doctor
- Hypospadias requires surgical correction any time between infancy and before school-going age
- The timing will be decided by your surgeon after evaluating penile growth
- More severe variants may require two-staged surgery
- Local or intramuscular testosterone may be prescribed to enhance penile growth before surgery
Circumcision Warning:
Do NOT circumcise a baby with hypospadias until evaluated by a pediatric urologist — the foreskin may be needed for surgical repair.