Hypospadias

In this congenital defect of the penis, the tube that passes urine from the bladder to the outside of the body (the urethra) opens on the underside of the penis or in the scrotum, instead of the end of the penis. In addition, bands of fibrous tissue on the underside of the penis often give it a sharp, downward curvature called chordee. Occasionally, boys with hypospadias also have other, less readily apparent, abnormalities of the urinary tract. To detect such abnormalities, the pediatrician may recommend an examination of the entire urinary system including the kidneys and bladder by means of special X-ray or imaging studies.

HOW DOES HYPOSPADIAS DEVELOP?
Hypospadias is a developmental defect originating in the fetus. Until the sixth week of embryonic life, rudiments of both male and female productive systems are present in the fetus. By eight weeks, the penis and urinary structures begin to form in the male fetus. The urethra develops as folds of tissue along the underside of the penis fuse together. Disruption of this fusion causes the urethral opening to form at an abnormal site.

WHAT TREATMENTS ARE AVAILABLE?
Hypospadias can be corrected surgically with an operation that releases the bands of fibrous tissue and diverts the urinary flow to a newly created urethral opening in the normal position. Whether surgery is necessary depends on how severe the defect is and whether it interferes with urinary or potential sexual function. If surgery is needed, it should be performed before the baby is 18 months old. In some cases, only one operation is needed, but in others, the operations are done six months to a year apart. In the case of mild hypospadias, surgery is primarily done for cosmetic reasons. Although the surgery is complex, it requires only a short hospital stay. Infants with hypospadias should not be circumcised because the foreskin may be useful in reconstructive surgery.

Children with hypospadias often have associated inguinal hernias. An inguinal hernia is visible as a bulge in the lower abdomen or scrotum.

COPING WITH HYPOSPADIAS

• If possible, correct the abnormality before toilet training starts. A boy with hypospadias may develop psychological problems if he must sit down to urinate and others see that his penis is not normal.

• Obtain counseling for the child, if necessary, to help him handle insensitive remarks from others if surgery does not create a completely normal appearance.

RECOGNIZING HYPOSPADIAS
Hypospadias is usually recognized during the baby's first examination in the hospital nursery. Signs associated with the condition include:

• Downward curvature of the penis

• A hood-like foreskin, rather than a foreskin that covers the glans completely

• Undescended testicles. (This occurs in about 1 to 10 boys with hypospadias.)

GETTING HELP
Call your doctor if:

• There is any abnormality in the appearance of your baby's genitalia

Excerpt from THE DISNEY ENCYCLOPEDIA OF BABY & CHILD CARE, © 1995 DSH Communications, Inc. This material is based on current medical research and, to the best of the editors' knowledge and understanding, is accurate and valid. However the reader should not use information contained in this material to alter a medically prescribed regimen or as a form of self-treatment, without seeking the advice of a licensed physician.