# Hypospadias - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Hypospadias Urogenital Reconstruction - StatPearls (NCBI Bookshelf NBK564407) - https://www.ncbi.nlm.nih.gov/books/NBK564407/ · Hypospadias - disease-level clinical article (hypospadias-full.txt) · Hypospadias - disease-level clinical article (hypospadias-clinical.txt) - Verified date: 2026-08 ## Verified against - Hypospadias Urogenital Reconstruction - StatPearls (NCBI Bookshelf NBK564407) - https://www.ncbi.nlm.nih.gov/books/NBK564407/ - Hypospadias - disease-level clinical article (hypospadias-full.txt) - Hypospadias - disease-level clinical article (hypospadias-clinical.txt) ## Treatment metadata - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text HYPOSPADIAS Sources: Hypospadias Urogenital Reconstruction - StatPearls (NCBI Bookshelf NBK564407) - https://www.ncbi.nlm.nih.gov/books/NBK564407/ · Hypospadias - disease-level clinical article (hypospadias-full.txt) · Hypospadias - disease-level clinical article (hypospadias- clinical.txt) Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Parents may notice the urethral opening is not in its usual place on the penis - A narrowed opening can splay or narrow the urine stream and wet the undergarments during voiding - Voiding while standing can be difficult - In adults, penile curvature - worse during erection - can impair intercourse and cause infertility by preventing semen deposition in the vagina [infertility] SIGNS - what you find (6) - Posterior disease can be accompanied by undescended testes and a bifid scrotum, which can look like ambiguous genitalia - The anterior, most common form has the opening on the glans, at the corona, or just below the corona - Middle hypospadias places the opening on the distal, mid, or proximal shaft of the penis - Posterior hypospadias places the opening at the penoscrotal junction, between the scrotal halves, or at the perineum with a bifid scrotum - Megameatus intact prepuce shows a coronal opening with a wide-open navicular fossa, an unfused glans, and a normal circular foreskin - Hypospadias sine hypospadias has curvature and a distorted foreskin despite the opening sitting in its normal position TESTS (5) - Endocrine work-up matters most when there is posterior disease, ambiguous genitalia, or undescended testes - Karyotyping and a 17-hydroxyprogesterone level are recommended as part of that endocrine work- up - Genitourinary ultrasound should be considered for posterior or complex disease - Half of perineal cases show Mullerian remnants such as a utricular cyst or a dilated utriculus, which can obstruct urine flow - Cystoscopy of the urethra can pick up abnormalities that ultrasound misses IF NOT THIS - what else fits (2) - Enzyme defects affecting dihydrotestosterone production, tied to the SRD5A2 gene, can cause varying degrees of incomplete masculinization - SRD5A2 mutations can present with a perineoscrotal opening and a female-appearing phenotype, distinguished from other disorders of sex development by marked virilization and no breast development at puberty Source Hypospadias - disease-level clinical article (hypospadias-full.txt) Status traced to the source above 1. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Hypospadias Urogenital Reconstruction - StatPearls (NCBI Bookshelf NBK564407) - https://www.ncbi.nlm.nih.gov/books/NBK564407/ Why There is no medical treatment and no drug to offer. The single primary-care action that changes this child's life is recognising it at the newborn check and stopping the circumcision, because the foreskin is the material the repair is built from. In Egypt, where circumcision is close to universal and often done outside a hospital, that is the whole point here. Caution DO NOT CIRCUMCISE. THIS IS THE ONE INSTRUCTION THAT MATTERS - hypospadias has to be excluded before any circumcision goes ahead, which means the genitalia are examined properly at birth, and again before a circumcision is booked. The hooded foreskin is not spare tissue; it is the graft. Tell the family explicitly, in front of whoever will arrange the circumcision. LOOK, EVERY TIME - examining the genitalia belongs to the routine newborn check, not to some special assessment. Hypospadias is among the commonest urogenital anomalies a newborn boy is born with, and second among congenital anomalies in boys behind the undescended testis alone. WHAT YOU ARE LOOKING FOR - three components. The urethral opening sits on the underside of the penis rather than at the tip. There is a ventral curvature, which is the chordee. And the foreskin is wrong: a hood of it over the top, too little of it underneath. Any one of the three should stop the circumcision and start the referral. HOW THE PARENTS DESCRIBE IT - the meatus is often narrowed, so the stream comes out thin or sprays sideways, and the underclothes get wet each time he passes urine. Passing urine standing up may be difficult. A boy who cannot aim is worth undressing. THE VARIANT THAT LOOKS NORMAL - in hypospadias sine hypospadias the meatus is where it should be, and only the chordee and the misshapen foreskin give it away. There is also the megameatus with intact prepuce, MIP, where the foreskin is complete and the anomaly is found only when it is retracted - sometimes on the circumcision table. SEVERE FORMS ARE AN ENDOCRINE EMERGENCY UNTIL PROVEN OTHERWISE - in the posterior forms the scrotum may be split and a testis undescended, and the appearance is then of genitalia that cannot be assigned by looking. A disorder of sexual development is commoner in these babies than in the anterior forms. Hypospadias with an impalpable testis is NOT a routine surgical referral - it needs urgent paediatric endocrine and urology assessment before any sex is registered or any operation is planned. The article adds that the posterior and the complex varieties call for endocrine, genetic and urological investigation beyond the examination. REFER EARLY AND TO SOMEONE WHO DOES THIS OPERATION - diagnosing it in good time and operating early have made a real difference to how these boys end up, in function and in appearance alike; reconstruction done early gives the best of both. Push the family towards a paediatric surgeon practised at it - and not only for the reconstruction itself, but for the follow-up that decides the long-term result. On timing the article is blunt: waiting gains little, and operating in early life spares the child the psychological weight of it. WHAT TO TELL THE FAMILY ABOUT THE ROAD AHEAD - roughly 25% of boys with hypospadias need a second operation. And left untreated it does not stay cosmetic: voiding is a problem, and in adult life so are sexual function and fertility, alongside how the man comes to see his own body. Say it once, plainly, so the family does not disappear after the first operation. IT RUNS IN FAMILIES - in 7% of boys a close relative has it too, the father or a brother. Ask, and examine the brothers. AFTER THE OPERATION, WHAT BRINGS THEM BACK - early, the article lists torsion of the penis, a urethrocutaneous fistula, necrosis of the flap, a wound that comes apart, haematoma, and oedema. Late: torsion again, chordee that persists, stricture, diverticulae, a fistula, and stenosis of the meatus. Urine leaking from anywhere other than the new meatus, or a stream that narrows again, goes back to the surgeon rather than to a course of antibiotics. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)