Hypospadias

About Hypospadias

Hypospadias is a congenital condition of the penis seen in boys, in which the urinary tube does not open at the tip of the glans. Instead, the opening lies on the underside of the penis, anywhere from just below the tip to as far back as the scrotum. It is the second commonest birth difference of the male genitalia, affecting about one in 250 boys.

During fetal development, hormones direct the formation of the urethra and foreskin. When this signalling is incomplete, the urethra fails to extend to the tip of the glans, producing the spectrum of hypospadias seen at birth. The condition can run in families and is sometimes associated with other congenital differences, so a careful examination of the whole baby is important.

Around 90 percent of cases are distal, with the meatus near the tip or head of the penis. The remaining 10 percent are mid-penile, proximal penile or scrotal, where the opening lies further back along the shaft or near the scrotum. Severe forms benefit from a karyotype, endocrine review and abdominal ultrasound to rule out intersex or undescended testes.

Children with hypospadias often need to sit while urinating and may have a curved or downward-pointing penis. While the condition is not life-threatening, it can cause emotional and social challenges as the child grows. Surgery, performed at an experienced centre, corrects the meatal position, straightens the penis and improves cosmesis so the child can develop confidently.

If the penis is small, a short course of testosterone or human chorionic gonadotropin may be given before surgery, with parental consent, to enlarge the tissues and increase the chance of successful urethral repair. Dr. Agarwal, FRCS Edinburgh, plans single-stage or staged operations based on severity and discusses expected outcomes with families during a thorough Lucknow consultation.

What to expect

• Detailed evaluation of the meatus, shaft and scrotum
• Karyotype and endocrine work-up for severe cases
• Ultrasound to assess undescended testes or hernia
• Pre-operative hormone stimulation when indicated
• Single-stage urethroplasty for distal hypospadias
• Staged repair for proximal or scrotal forms
• Long-term follow-up through childhood and adolescence

Recovery

• Hospital stay of one to two nights typically
• Soft dressing and urinary catheter for several days
• Antibiotics and analgesics as prescribed
• Loose-fitting clothing and gentle hygiene
• Avoid straddling toys or cycling for several weeks
• Follow-up reviews to assess healing and stream