II. Epidemiology
- Incidence: 1 in 150 per male births
III. Predisposing factors: Family History
- Father with Hypospadias: 8% risk
- Brother with Hypospadias: 14% risk
IV. Pathophysiology
V. Associated Conditions
- Undescended Testicle (10% association)
- Inguinal Hernia
- Hydrocele
- Chordee (ventral penile curvature)
VI. Classification
- Anterior (Distal penis and glans): 50% of cases
- Middle (Midshaft of penis): 30% of cases
- Posterior (Scrotum, Perineum): 20% of cases
VII. Management
- Avoid Circumcision (foreskin needed for repair)
- Pediatric urology referral at age 3 to 4 months
- Surgical repair at 6 to 12 months of age
- Distal Hypospadias (most common)
- Typically repaired in a single surgery (curvature repaired at same time)
- Urethral catheter is typically in place for 1 week following surgery
- Few complications
- Proximal Hypospadias
- Evaluate for disorder of Sexual Development if Undescended Testicle also present
- Often requires 2 procedures for repair (esp. if severe curvature)
- Second surgery if needed is performed at 6 months
- Uses foreskin for repair graft (if second procedure needed)
- Distal Hypospadias (most common)
VIII. Complications: Surgical Repair
- Complications 5-15% (highest for posterior Hypospadias)
- Urethrocutaneous fistula or Urethral Diverticulum
- Meatal stenosis
- Wound Infection, Hematoma or dehiscence
IX. Complications: Utreated
- Urine stream deformity
- Sexual Dysfunction associated with curvature
- Infertility associated with proximal Urethral meatus
X. References
- Behrman (2000) Nelson Pediatrics, Saunders, p. 1645-7
- Granberg (2024) Mayo Clinic Pediatric Days, lecture attended 1/18/2024
- Borer (1999) Urol Clin North Am 26(1): 15-37 [PubMed]
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| Definition (NCI_NCI-GLOSS) | A birth defect in which the opening of the urethra (the tube through which urine leaves the body) is not in its normal place. In males with hypospadias, the urethra opens on the underside of the penis or between the anus and the scrotum. In females with hypospadias, it opens into the vagina. Hypospadias is much more common in males than in females, and can be corrected by surgery. Children with hypospadias have an increased risk of developing Wilms tumor (a type of kidney cancer). |
| Definition (NCI) | A congenital abnormality in which the external urethral orifice is on the underside of the penis. In a minority of cases it is associated with other genitourinary abnormalities. |
| Definition (MSH) | A birth defect due to malformation of the URETHRA in which the urethral opening is below its normal location. In the male, the malformed urethra generally opens on the ventral surface of the PENIS or on the PERINEUM. In the female, the malformed urethral opening is in the VAGINA. |
| Concepts | Congenital Abnormality (T019) |
| MSH | D007021 |
| ICD10 | Q54 , Q54.9 |
| SnomedCT | 416010008 |
| LNC | LA20090-9 |
| English | Hypospadia, HYPOSPADIAS, Hypospadias, unspecified, Hypospadias [Disease/Finding], hypospadia, hypospadias, Hypospadias (disorder), Hypospadias |
| French | HYPOSPADIAS, Hypospadias, Hypospade |
| German | HYPOSPADIE, Hypospadie, nicht naeher bezeichnet, Hypospadie |
| Swedish | Hypospadi |
| Czech | hypospadie |
| Finnish | Hypospadiat |
| Russian | GIPOSPADIIA, ГИПОСПАДИЯ |
| Portuguese | HIPOSPADIAS, Hipospadia |
| Spanish | HIPOSPADIAS, Hipospadia, hipospadias (trastorno), hipospadias, Hipospadias |
| Korean | 요도하열, 상세불명의 요도하열 |
| Croatian | HIPOSPADIJA |
| Polish | Spodziectwo |
| Norwegian | Hypospadi |
| Dutch | Hypospadie, niet gespecificeerd, Hypospadie |
| Italian | Ipospadia |
