Hypospadias in Children: Causes and Symptoms

What is hypospadias?

Hypospadias is a condition occurring in baby boys when the prepuce (foreskin), glans (the tip of the penis), and the anterior urethra (tube carrying the urine from the bladder to the outside of the body) do not form properly during pregnancy. Because of this incomplete development, the meatus (opening of the urethra) can be located along any part of the underside of the penis.   

Hypospadias can be mild, moderate or severe, depending on where the opening of the urethra is located. The majority of hypospadias cases are in the “distal” position, meaning that the meatus is found near the end of the penis. The less common “posterior” or “proximal” position refers to when the urethra opening is located in the middle of the penile shaft, the base of the penis, or even in the scrotum.

Hypospadias also affects the foreskin. It does not properly develop, creating extra foreskin on the top side of the penis and very little foreskin on the underside of the penis.

Which other medical conditions may happen in children who have hypospadias?

Other medical conditions you may see in children with hypospadias include ventral penile curvature (also called a chordee, when the head of the penis curves upward or downward) and redundant foreskin (foreskin that is longer than usual).  When the urethra opening is located further down the shaft, it is more likely that the penis will be curved. It is also possible for boys born with hypospadias to have inguinal hernias, undescended testicles, or both.

In the majority of cases, hypospadias is the only developmental problem at birth.

What causes hypospadias in children?

Hypospadias congenital (present at birth). The penis develops during weeks 9-12 of pregnancy, when male hormones instruct the body to form the urethra and foreskin. The urethra starts forming as an open channel and gradually closes over time as the fetus develops. In the case of hypospadias, the tissue on the underside of the penis doesn’t close completely, thus shortening the passageway of the urethra.

The exact causes of hypospadias are unknown, but it is likely caused by a combination of genetic and environmental factors during pregnancy. Researchers from the CDC predict the following findings as increased risk factors for hypospadias:

• The use of assisted reproductive technology/fertility and hormone treatments during pregnancy
• Use of other hormones before or during pregnancy
• Mothers over the age of 35
• Mothers who have obesity
• Fathers and/or brothers of the baby also had the condition
• The baby has a low birth weight or is born preterm 

What are the symptoms of hypospadias?

Possible symptoms of hypospadias include:

• Abnormal location of the urethra: Location varies, but it is not at the tip of the glans where it should be
• Penile curvature (curve along the shaft of the penis)
• Extra foreskin on the top side of the penis with little to no foreskin on the underside of the penis
• Urinary stream that flows downward instead of straight
• Infertility problems later in life