What is Hypospadias?
Hypospadias is a birth defect of the male urethra. The opening of the urethra appears along the undersurface of the penis instead of the tip of the head of the penis. Boys with hypospadias may also have a downward curvature of the penis with erections (a condition called chordee) and a “hooded” foreskin, where the foreskin is present along the top of the penis but not along the bottom.
Boys born with hypospadias are generally diagnosed with the condition at the time of birth. In general, circumcision is not performed as it is possible that the skin will be needed for use in reconstructing the urethra. Corrective surgery is often performed during the first year of life. However, some boys born with hypospadias, especially those born outside of the United States, are managed without surgical correction, and decide to have corrective surgery in adulthood.
The objective of the hypospadias repair is to correct any downward curvature, reconstruct the urethra so that the urethra is of adequate size with the opening at the tip of the penis, and to provide a nice cosmetic appearance. The choice of surgical technique is made on a case-by-case basis. Most boys born with hypospadias are referred for treatment by Pediatricians to their local Pediatric Urologist. Since we only treat disorders of the male pediatric and adult male urethra and penis, the Center for Reconstructive Urology is not a “go to” resource for Pediatricians, and most Pediatric Urologist are very well qualified to perform hypospadias repair. Often, the surgery is successful.
Unfortunately, hypospadias surgery can be associated with several complications including a breakdown of the repair, urethral stricture disease, incomplete correction of downward curvature, and/or urethrocutaneous fistulas (abnormal holes connecting the urethra and skin casing urine to exit at the site of the fistula in addition to the urethral opening. In cases where multiple surgeries are performed using additional penile skin, tethering of the penis can occur due to penile skin deficiency. The Center for Reconstructive Urology is a referral center for the treatment of these complex cases. Nearly all patients are referred by their Pediatric Urologists.
In addition, adults often seek hypospadias treatment for untreated hypospadias. More commonly, adults are referred to our Center for the treatment of complications of hypospadias surgery such as urethral stricture disease and urethrocutaneous fistulas.