Hypospadias

Hypospadias is a congenital condition in males in which the opening of the urethra is not at the tip of the penis but located along the underside of the penis, anywhere from the glans to the perineum. It results from incomplete fusion of the urethral folds during fetal development and is often accompanied by penile curvature (chordee). The condition is classified by the position of the meatus into distal (glanular or coronal), penile shaft, proximal (penoscrotal), and perineal variants.

Most cases occur in otherwise healthy newborns, and the cause is multifactorial, involving genetic predisposition and environmental influences. It is not caused by neonatal circumcision. Hypospadias may be isolated or associated with other genital anomalies, such as undescended testes or inguinal hernias.

Diagnosis is usually made at birth through physical examination. Additional evaluation may be performed to assess urinary function and to screen for associated anomalies if indicated. In rare cases, prenatal imaging may suggest the condition.

Treatment typically involves surgical repair to relocate the urethral opening to the tip of the penis, straighten any curvature, and achieve a functionally normal urinary stream. Surgery is commonly performed between 6 and 18 months of age, though the exact timing depends on the type and severity. Proximal or more complex hypospadias may require staged procedures. Hormonal therapy prior to surgery is used selectively in some cases. Potential surgical complications include fistula, urethral stenosis, recurrent curvature, and the need for additional procedures.

Prognosis is generally favorable with appropriate repair, providing reliable urination and improved cosmetic and functional outcomes. Long-term follow-up may be needed to address urinary or sexual function as the individual matures.