Hypospadias (hi-poe-SPAY-dee-us) is a condition in which the opening of the urethra is on the underside of the penis, instead of at the tip. The urethra is the tube through which urine drains from your bladder and exits your body.

You may feel distressed if your son is born with hypospadias. However, hypospadias is common and doesn't cause difficulty in caring for your infant. In fact, surgery usually restores the normal appearance of your child's penis. With successful treatment of hypospadias, most males can eventually have normal adult sexual function.

In hypospadias, the opening of the urethra is located on the underside of the penis instead of at the tip. The severity of the condition varies. In most cases, the opening of the urethra is near the head of the penis. Less often, the opening is at midshaft or at the base of the penis. Rarely, the opening is in or beneath the scrotum.

Signs and symptoms of hypospadias may include:

  • Opening of the urethra at a location other than the tip of the penis
  • Downward curve of the penis (chordee)
  • Hooded appearance of the penis because only the top half of the penis is covered by foreskin
  • Abnormal spraying during urination

When to see a doctor

Most infants with hypospadias are diagnosed soon after birth while still in the hospital.

However, it's possible that less severe hypospadias may be overlooked. Call your doctor if you notice your son's urethral opening is not at the tip of the penis, his foreskin is not fully developed or his penis curves downward.

Hypospadias is present at birth (congenital). The exact reason this defect occurs is unknown. Sometimes hypospadias is inherited.

As the penis develops in a male fetus, certain hormones stimulate the formation of the urethra and foreskin. Hypospadias results when a malfunction occurs in the action of these hormones, causing the urethra to develop abnormally.

Though the cause of hypospadias is unknown, both environmental and genetic factors have been associated with the condition, including:

  • Family history. This condition is more common in infants with a family history of hypospadias.
  • Maternal age over 40. Some research suggests that there may be an increased risk of hypospadias in infant males born to women of an advanced age.
  • Exposure to smoking and chemicals. There is some speculation about an association between a mother's exposure to pesticides and hypospadias, but further studies are needed to confirm this.

If hypospadias is not treated, a child may have problems learning to use a toilet properly. During adulthood, untreated hypospadias can cause difficulty in achieving an erection.

If your infant son is diagnosed with hypospadias while still in the hospital after birth, you'll likely be referred to a pediatric urologist.

If your child's hypospadias is less severe, however, it may be overlooked in the hospital. If you think your son has hypospadias, call your family doctor or pediatrician.

If your child will be seeing a pediatric urologist, you may want to check your health plan to see if it covers meeting with this specialist.

It's a good idea to arrive well prepared to your appointment. Here's some information to help you get ready, as well as what to expect from your doctor.

What you can do

  • Ask a family member or friend to come with you. It can be upsetting to find out that there's something wrong with your child, possibly making it difficult to remember all of the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write down questions to ask your doctor.

For hypospadias, some basic questions to ask your doctor include:

  • Does my child need to have surgery?
  • When is the best time for surgery?
  • What are the risks associated with this surgery?
  • Could my child outgrow this condition?
  • What happens if he doesn't have the surgery?
  • Will this condition affect my son's fertility or sexual function later in life?
  • If I have another child, what are the odds that this might happen again?
  • Are there brochures or other printed material that I can take with me? What websites do you recommend?

What to expect from your doctor

It's also a good idea to be prepared for any questions your son's doctor may ask. For hypospadias, he or she might ask:

  • Does your son's penis curve downward during erection?
  • Have you noticed any abnormal spraying when your son urinates? (This may be difficult to distinguish in an infant.)

Your son's doctor can diagnose hypospadias based on a physical examination. In cases of severe hypospadias, such as the absence of testicles in the scrotum, a sex determination evaluation may be performed.

Treatment involves surgery to reposition the urethral opening and, if necessary, straighten the shaft of the penis.

What happens during surgery

During surgery, a pediatric urology surgeon uses tissue grafts from the foreskin or from the inside of the mouth to reconstruct the urinary channel in the proper position, correcting the hypospadias. The surgery usually takes from one to three hours and is done while the child is unconscious (general anesthesia). Rarely, the repair may require two or more surgeries.

When surgery is performed

Surgery is best done at an early age — usually between ages 3 months and 18 months. Generally, the earlier the surgery is done, the less traumatic it is for the child. But the procedure can be completed at any age and even into adulthood. Infants should not be circumcised before the procedure because the foreskin tissue may be needed for the surgery.

Complications of surgery

In most cases, surgical repair results in a penis with normal or near-normal function and appearance and no future problems. However, in a small number of cases, a hole (fistula) or scarring may develop along the underside of the penis where the new urinary channel was created. This can result in urine leakage and require an additional surgery for repair.

Learning that your son has hypospadias and will likely need surgery may cause you to worry or be anxious. Don't hesitate to ask your child's doctor any questions you have, and if possible, have a family member or friend with you for support on the day of the surgery. The good news is that the surgery for hypospadias is usually very successful, and your very young child will probably not recall having the procedure.

    • Experience and expertise. More than 200 children with hypospadias receive care each year at Mayo Clinic. Your child will be treated by a board-certified pediatric urology surgeon. Doctors at Mayo Clinic have extensive experience with primary surgery as well as complicated follow-up procedures, and they perform surgery to correct hypospadias on a weekly basis.
    • Time for your questions and concerns. Doctors will take the time to listen to your concerns and answer all of your questions about your son's care.
    • Children's care. Mayo Eugenio Litta Children's Hospital and Mayo Clinic pediatric and adolescent medicine specialists provide comprehensive care for the diagnosis and treatment of virtually any medical problem in children, including hypospadias. Children at Mayo Clinic have access to the latest medical treatments and technology, along with groundbreaking clinical trials, in a caring, patient-centered environment.
  • The treatment for hypospadias is surgery. Mayo Clinic specialists will advise you about when your child should have the surgery and types of operations.

    • Timing. Surgery is usually done between the ages of 6 and 12 months. However, it can be done even in adulthood.
    • Success rate. Surgery is usually highly successful. Most of the time the penis will look normal after surgery, and boys have normal urination, sexual function and fertility.
    • Setting. Most surgeries can be done on an outpatient basis (no overnight stay in the hospital). Most out-of-town families stay near the clinic for five or six days for follow-up care.
    • The surgery. Boys with hypospadias should not be circumcised, so that the foreskin can be used for surgical repair. Doctors straighten the penis, if necessary. Surgery is done under general anesthesia and usually takes about 90 minutes.

    Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people. In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.

    The expertise of the Urology Department at Mayo Clinic covers the spectrum of clinical urology, including pediatrics. Experienced, board-certified urology specialists treat hypospadias at Mayo Clinic in Rochester, Minn., on a weekly basis. For appointments or more information, call the Urology Appointment Office at 507-293-0933 between 8 a.m. and 5 p.m. Central time, Monday through Friday.

    For appointments or more information, call the Central Appointment Office at 507-538-3270 7 a.m. to 6 p.m. Central time, Monday through Friday or complete an online appointment request form.

    See information on patient services at the three Mayo Clinic locations, including transportation options and lodging.

    See a list of publications by Mayo Clinic doctors on hypospadias on PubMed, a service of the National Library of Medicine.

    Jan. 22, 2011