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Hypospadias is one of the most common fetal developmental problems in the United States. It affects approximately 1 in 200 babies with a penis.

If your child is one of these babies, it’s natural to be concerned about the next steps. Here’s everything you need to know about hypospadias, including its causes, treatment, and your baby’s long-term outlook.

Hypospadias is a birth defect, which means it is present at birth. It can affect any baby born with a penis.

If someone has this condition, the opening to their urethra, called the meatus, is not located at the end of their penis. Instead, it’s located somewhere below the tip of the penis and scrotum.

In general, there are several types of hypospadias:

  • Subcoronary hypospadias. This is when the meatus is in the distal position, which means it is near the end of the head of the penis, but not at the tip. This type of hypospadias is the most common. She touches more than 80 percent people with hypospadias.
  • Mid-diaphyseal hypospadias. This is when the meatus is located along the shaft of the penis in what doctors call a proximal position.
  • Penoscrotal hypospadias. This is when the meatus is located somewhere near where the base of the penis and the scrotum meet. It is one of the most serious types of hypospadias.
  • Scrotal or perineal hypospadias. It is the rarest form of hypospadias. It occurs when the meatus is located in the scrotum or behind the scrotum.

The most obvious symptom of hypospadias is that the meatus is not located at the tip of the penis but rather below the tip, along the shaft or at the base of the penis. Its location determines the diagnosis.

Other symptoms include:

  • A penis that curves slightly downward. This is called chordate. It occurs in about 15 percent people with hypospadias.
  • Difficulty urinating. This happens due to the spraying of urine from areas other than the tip.
  • Incompletely formed foreskin. This means your baby may be born looking partially circumcised because the foreskin forms on the back of the penis but doesn’t go all the way around.
  • An undescended testicle. This happens when one or both testicles remain inside the body rather than descending into the scrotum, which is the skin sac that contains the testicles.

If left untreated, hypospadias can also cause other problems, such as making it difficult to have sex or urinating while standing.

Both hypospadias and epispadias are congenital problems but epispadias can affect any gender whereas hypospadias only affects those who have a penis.

Epispadias resembles hypospadias. In epispadias, the tube through which urine leaves the body is fully developed but does not form a tube. In hypospadias, the urethra is a tube but it does not reach the tip of the penis.

Epispadias is very rare than hypospadias: it affects 1 in 117,000 newborns with a penis and 1 in 484,000 newborns with a vagina.

In babies with a penis, epispadias can cause the tip of the penis to split and open, or it can cause the opening of the urethra to be located elsewhere in the penis.

In babies with a vagina, the opening of the urethra may be located between the clitoris and the labia, or even in the stomach area.

Doctors and researchers aren’t sure exactly what causes hypospadias, although research is ongoing.

However, experts believe that hypospadias is likely caused by a combination of genetic, environmental and hormonal factors that change or stop the development of the penis in utero, somewhere before or during the 5th month of pregnancy.

A pediatric urologist usually diagnoses hypospadias soon after birth.

The doctor will examine the child, identify the location of the meatus, assess the curvature of the penis and determine the severity of the case.

During this evaluation, the doctor can take steps to help determine the best treatment option.

If your child has no chordate (curvature of his penis) and his hypospadias is mild, with the meatus near the end, he may not need surgery.

If hypospadias is more severe, treatment usually involves surgery to help repair and rebuild the urethra so that it extends to the tip of the penis. Any curvature of the penis will be treated at the same time.

Your child should not be circumcised before this repair, as additional tissue may be needed as part of the procedure.

The surgery is usually outpatient and usually done when the child is between 6 months and 18 monthsalthough some surgeries can be performed on children as young as 3 months.

Although doctors don’t know exactly what causes hypospadias, there are some known risk factors, including:

  • Genetic. You are more likely to have a baby born with hypospadias if another close family member with a penis also had the condition.
  • Hormones. Since the penis and foreskin grow in utero with the help of hormones such as testosterone, it is possible for environmental factors to affect these hormones and cause hypospadias.
  • The age of the pregnant mother. Babies born to parents over 35 are more likely to have hypospadias.
  • In vitro fertilization (IVF) and certain other fertility treatments. IVF and other fertility treatments can increase the risk of a baby being born with hypospadias.
  • Premature birth or low birth weight. Babies born early or with low birth weight are more likely to have hypospadias.

In general, the outlook for children with hypospadias is good. Many children who have it surgically repaired grow up with normal functioning penises.

However, as with all surgical procedures, complications can occur. Complications are more likely in cases of more severe hypospadias.

Complications that may arise include:

  • leaking urine or a new hole (called a fistula) forming elsewhere in the penis
  • a large blood clot
  • scarring in the canal or meatus, making it harder to urinate
  • meatal stenosis, which narrows over time as the urethra opens
  • permanent curvature of the penis
  • a need for repeat surgery to repair complications
  • a need for plastic surgery to repair aesthetic problems

The risk of complications is highest in the months following surgery. Long-term exams are usually needed to monitor your child’s penis and make sure problems don’t develop as they grow.

Some children may benefit from meeting with a pediatric psychologist, particularly at the onset of puberty, to help them manage and overcome any body image issues.

It can be scary to learn that your child was born with a condition like hypospadias.

However, hypospadias can be repaired with treatment. In many cases, your child will grow up to have a perfectly functioning and typical penis.