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What is hypospadias?
Hypospadias is a congenital condition (present from birth) that affects how the urethra develops in a baby boy. Instead of opening at the tip of the penis, the urethral opening is located somewhere along the underside, which can affect urination and the appearance of the penis. It is a fairly common birth defect, estimated to impact around 1 in every 200 babies.
Not all cases of hypospadias require treatment. In milder forms, where there are no functional concerns, surgery may not be necessary. For more significant cases, we offer hypospadias repair surgery to reposition the urethral opening, improve urinary function and, where needed, straighten the penis or reconstruct the foreskin. Treatment is tailored to your child’s needs and is typically performed after 12 months of age.
Hypospadias treatment is provided by specialists at Evelina London Children’s Hospital, as part of our paediatric urology service, where your child will receive expert assessment, surgical care and ongoing support in a dedicated children’s setting.
Experts in children's urology
Fast access to diagnosis and treatment for hypospadias and related conditions, our specialists offer:
- short-notice appointments, often available within 24 hours
- accurate diagnosis from paediatric urology specialists
- quick access to treatment, including surgery within 1 week
Types of hypospadias
Hypospadias occurs when the opening of the urethra (the tube that carries urine from the bladder to the outside of the body) isn’t located at the tip of the penis. The urethra normally forms early in foetal development at around 8–14 weeks gestation. However, in babies with hypospadias, the opening of the urethra forms anywhere from just below the end of the penis to the scrotum.
Hypospadias is split into 3 different types. The variety that your child is diagnosed with will depend on the location of the opening of the urethra.
Distal hypospadias
Where the opening of the urethra is located on or near the head of the penis, but not on the tip.
Midshaft hypospadias
The opening of the urethra is located along the shaft of the penis.
Penoscrotal hypospadias
Characterised by a urethra opening located where the penis and scrotum meet.
Your paediatric urologist will be able to tell you which type your child has after the examination.
Hypospadias is split into three different types.
Hypospadias symptoms in children
Checking for hypospadias is usually part of the routine examination of babies after they are born. However, other signs and symptoms of hypospadias include:
- visible opening of the urethra in a location other than the very tip of the penis
- downward curve of the penis
- hooded appearance of the penis due to only the top half of the penis being covered by foreskin
- abnormal spraying during urination
In some instances, it’s possible to detect severe hypospadias before your baby is born during an ultrasound. However, it is much more likely to be noticed during the physical examination of your baby after birth.
If you’ve noticed any of the above in your child, get in touch to book an appointment for an assessment.
What causes hypospadias?
Hypospadias is a congenital condition, which means that it is present at birth and happens during foetal development. The reason why some children develop hypospadias and others don’t is normally unclear.
However, some factors are believed to increase the risk of a baby being born with the condition. These include:
- a family history of hypospadias
- specific genetics that disrupt the hormones responsible for the formation of a penis
- pregnancy in those considered obese
- pregnancy in those over the age of 35
- taking certain hormones just before or during pregnancy
Hypospadias complications
There are several different complications associated with hypospadias. The most obvious is problems with urinating. When the opening isn’t located at the end of the penis, it can be much harder to control the direction of urine flow.
If not corrected this can lead to abnormal spraying of urine, and many children with uncorrected hypospadias find it easier to sit down to urinate.
Children with hypospadias can sometimes experience an abnormally curved penis, and a small percentage also experience undescended testicles, where the testicles do not drop into the scrotum shortly after birth.
Issues with impaired ejaculation direction can also occur in adulthood. Abnormal curvature of the penis and impaired ejaculation can cause problems with sexual intercourse and fertility.
Diagnosing hypospadias
Hypospadias is usually diagnosed by a paediatric urology specialist through a physical examination of your child’s penis shortly after birth.
Hypospadias repair
Not all cases of hypospadias require treatment. In milder forms, where there are no functional concerns, surgery may not be necessary.
However, for more significant cases, surgery is often recommended to improve urinary function and reduce the risk of complications later in life. This is typically performed when your child is over 12 months old.
Hypospadias repair is carried out as a day-case procedure under general anaesthetic. The operation may involve repositioning the urethral opening, straightening the penis and reconstructing the foreskin, depending on the severity of the condition and parental preference. In more complex cases, tissue grafts from the foreskin or inside the mouth may be used to rebuild the urinary channel.
Children’s day surgery unit
Many hypospadias procedures are carried out in our dedicated children’s day surgery unit at Evelina London, designed to support faster recovery and minimise disruption for families. This means your child can have surgery and return home on the same day, where appropriate.
Our day surgery approach offers a number of benefits:
- shorter hospital stays, allowing your child to recover in the comfort of home
- specialist paediatric care in a child-friendly environment
- efficient treatment pathways, helping reduce waiting times and anxiety
Our experienced team will guide you through the process and ensure you feel confident and supported before, during and after your child’s procedure.
Get in touch about hypospadias treatment
Our paediatric urology specialists at Guy’s and St Thomas’ Specialist Care provide expert care for children with hypospadias, offering personalised treatment and support at every stage.
If you have questions about hypospadias or are considering surgery for your child, contact our team for expert advice and next steps.
Reviewed regularly to reflect clinical best practice
Last reviewed: 01 March 2024
Locations
Our specialists can offer treatment for hypospadias in the following locations:
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