Hypospadias in Children: Diagnosis and Treatment

How is hypospadias diagnosed?

If the hypospadias is severe, doctors may diagnose it prenatally (before birth) through an ultrasound. However, it is more common for a family member or doctor to notice the condition after your baby is born. This is because the penis may look unusual. A pediatric urologist or pediatric surgeon can diagnosis hypospadias with a physical examination.   

After hypospadias is diagnosed, what is the treatment plan?

The best treatment for hypospadias is surgery. Hypospadias surgery creates a normal opening of passage of urine (urethral meatus), a straight penis and a normal position of the scrotum in relation to the penis. These repairs can be 90 minutes for distal hypospadias or 3 hours for proximal hypospadias.  

During surgery, doctors may place a stent (small tube that helps keep the urethra open) or a catheter (plastic tube placed in the urethra to help urine flow out of the body). The catheter drains into a diaper, and will be removed at one of your child’s follow-up appointments. Antibiotics are often supplied while the catheter is in place.

A Note about circumcision...

If your child has hypospadias, they should not be circumcised at birth. Doctors will use the foreskin during the hypospadias repair. Your child’s penis will have a circumcised appearance after the hypospadias repair. 

When should my child have hypospadias surgery?

Hypospadias surgery is best performed between 6 months of age and 3 years of age (before your child is toilet trained). This is when the risks of psychologically stressing your child and of using general anesthesia are both low.

Will my child need to stay in the hospital after surgery?

It depends of the severity of the hypospadias and how your child is doing after surgery. Some will spend one night in the hospital and be discharged the following day, while others leave that same day. A portion of babies can go home with no catheter in place, while others will leave the hospital with a stent in their penis that drains into a diaper. Usually the tube is removed around one week after surgery, and the penis should not be submerged in water before then. The pediatric surgeon will let you know what to expect.

What are the risks and recovery processes of hypospadias surgery?

After surgery, your child will be able to drink and eat right away. Minor swelling and pain is normal and can be treated with ibuprofen and acetaminophen at home. Your doctor may also prescribe an antibiotic to prevent bladder spasms. Limit physical activity for your child for the first two weeks after surgery. Following two weeks, they will usually have a post-operative checkup with their doctor and their stitches will be dissolved.

While boys rarely experience complications following hypospadias surgery, problems are more likely to happen following a proximal hypospadias correction. Infection and bleeding are rare, and the most common problem following surgery is a hole (fistula) that forms in another place on the penis. Additionally, scars may form in the urethra that could interfere with urination. If your child experiences urine leaking from a second hole or a decreased urinary stream, call a pediatric urologist immediately.

Both of these complications require a second surgery. Your child must wait at least six months following their hypospadias surgery to allow their tissues to heal before undergoing a second procedure to close fistulas or remove scarring.