Penile Malformations

What is hypospadias?

Hypospadias is a malformation that affects the urethral tube and the foreskin on a male's penis. The urethra is the tube that carries urine from the bladder to the outside of the body. Hypospadias is a disorder in which the male urethral opening is not located at the tip of the penis. The urethral opening can be located anywhere along the urethra. Most commonly with hypospadias, the opening is located along the underside of the penis, near the tip.

What causes hypospadias?

Hypospadias is a congenital (present at birth) anomaly (abnormality), which means that the malformation occurs during fetal development. As the fetus develops, the urethra does not grow to its complete length. Also during fetal development the foreskin does not develop completely, which typically leaves extra foreskin on the topside of the penis and no foreskin on the underside of the penis.

Who is affected by hypospadias?

Hypospadias is a disorder that primarily affects male newborns. It occurs in about three in 1,000 male births.

Hypospadias also has a genetic component. Some studies have shown fathers of males with hypospadias to also have had the condition. Other studies have shown fathers of males with hypospadias also had the condition.

Some newborn boys who have other congenital abnormalities such as undescended testes or inguinal hernias may also have hypospadias.

What are the symptoms of hypospadias?

The following are the most common symptoms of hypospadias. However, each child may experience symptoms differently. Symptoms may include:

  • abnormal appearance of foreskin and penis on exam
  • abnormal direction of urine stream
  • the end of the penis may be curved downward
  • The symptoms of a hypospadias may resemble other conditions or medical problems.

How is hypospadias diagnosed?

A physician or healthcare professional usually diagnoses hypospadias at birth. The malformation can be detected by physical examination.

Treatment for hypospadias:

Specific treatment for hypospadias will be determined by your child's physician based on:

  • your child's age, overall health, and medical history
  • the extent of the disease
  • your child's tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

Hypospadias can be repaired with surgery. Usually, the surgical repair is done when your child is between 6 and 12 months, when penile growth is minimal. At birth, your male child will not be able to undergo circumcision, as the extra foreskin may be needed for the surgical repair. The surgical repair can usually be done on an outpatient basis.

If a hypospadias deformity is not repaired, the following complications may occur as your child grows and matures:

Your child's urine stream may be abnormal. The stream may point in the direction of the opening, or it may spread out and spray in multiple directions. The penis may curve as your child grows causing sexual dysfunction later in life. If the urethral opening is closer to the scrotum or perineum, your child may have problems with fertility later in life.


Epispadias, which is less common than hypospadias, may also be seen in children with spina bifida or exstrophy of the bladder (a condition where the bladder may appear to be inside out and the abdominal wall is partially open leaving the bladder exposed to the exterior of the body), occurs when the urethral opening is in an abnormal location. In contrast to hypospadias, with epispadias, the urethral opening in a male is usually located on the topside (not the underside or tip) of the penis.