What is Hypospadias?

Hypospadias is condition that boys are born with.  It affects their penis.  It can have a number of components, which can include:

  • The foreskin being wide open.  This may be called a ‘Hooded Foreskin’.
  • The pee tube does not open in the correct place.
  • The penis may be bent over during an erection (this is called chord)
  • The penis may be shorter.
  • In very severe cases the scrotum may be in two halves.

The position of the opening of the pee tube may be just below where it should be.  This is called a “Distal Hypospadias”.  If the pee tube opens closer to the base of the penis or between the boys legs then this is a more severe form of hypospadias called a “Proximal Hypospadias”.

Distal vs Proximal Hypospadias

How common is Hypospadias?

Approximately 1 boy out of every 300 is affected by hypospadias.  Distal Hypospadias is more common than Proximal Hypospadias.  The incidence of hypospadias is increasing (meaning that we are seeing more cases of hypospadias than we used to.)

What Causes Hypospadias?

We do not know exactly what causes hypospadias.  It is more common in premature babies, and in some families. 

How is Hypospadias Diagnosed?

Hypospadias is diagnosed by a careful examination of the boys genitalia.  As well as examining the penis it is important to examine the scrotum and confirm that the boy has both testicles present.

Are any investigations needed?

Investigations are normally not needed to make the diagnosis or plan treatment in boys with Hypospadias. 

In some rare cases, where a boy is thought to have hypospadias and the testicles cannot be found in the scrotum or the groin, then some further investigations may be needed.  This will include blood tests.  If this is the case your doctor will discuss this with you.


What are the Problems with Hypospadias?

In the short term hypospadias does not cause any health problems for boys.

Untreated hypospadias may cause a number of problems for boys when they grow.  These problems may include:

  • Difficulty urinating.  Often the opening of the pee tube is narrow, meaning that when boys pee, the urine sprays out.  The other problem that boys have is that because the pee tube opens up on the underside of the penis, boys need to sit down to pee.  Urinals become impossible for some boys
  • Sexual activity can be uncomfortable.  Some adults who have uncorrected hypospadias avoid sexual intercourse because of this discomfort.  As well as the discomfort, sexual intercourse can be difficult because of the bend of the penis (chordee) and the fact that the penis tends to be shorter.This does not mean that all men with hypospadias will have difficulties.  Some men (who tend to have the more minor types of hypospadias) have no difficulties with sex.
  • Some men have psychological issues because of their hypospadias.  They can become embarrassed or depressed and try to avoid having a sex life. 

How is hypospadias treated?

In the majority of cases hypospadias is treated with surgery.  The surgery that is offered depends on the severity of the hypospadias. 


Hooded Foreskin

In minor cases - those with Hooded Foreskins - there are 3 options for treatment:

  • To do nothing. 
  • To reconstruct the foreskin.
  • To perform a completion circumcision.


Distal Hypospadias

Distal hypospadias can be repaired with a single operation.  The surgery can be done as a day case.  The foreskin can be reconstructed or a circumcision can be performed as part of the hypospadias repair.


Proximal Hypospadias

For proximal hypospadias - cases where the pee tube opens at the base of the penis or between the legs - then a staged repair is used.  This means that at least 2 operations are required.  At the first procedure the penis is straightened and a skin graft is placed on the underside of the penis which will allow the penis to be reconstructed at the second operation. A second procedure is done after a minimum of 6 months from the first surgery.  At this operation the penis is rebuilt.

Proximal hypospadias repairs have a much higher complication rate than distal hypospadias repairs.

If a skin graft is needed, the best skin to use is from the foreskin.  It is important that a boy with a hypospadias is NOT circumcised before the hypospadias surgery so that if a skin graft is needed, it is available.


Click the button below to download my Hypospadias Information Sheet


For Patients and Parents


Everything you wanted to know about hypospadias but were too afraid to Google

This is an excellent article from the Telegraph.

The information provided in this information leaflet id meant to provide general information only.  It does not replace a consultation with a doctor who will be able to give you information tailored to the patient.