Hypospadias and other common penile abnormalities in babies

Written by: Miss Marie-Klaire Farrugia
Edited by: Jay Staniland

Hypospadias is a common condition, affecting around 1 in 350 male births. It is an abnormality of the penis, where the opening of the penis where the wee comes out (urethral meatus) is not at the end of the penis, where it should be, but positioned on the under surface of the penis.

The most common location of the meatus in cases of hypospadias is the corona (the junction between the glans and shaft), but the opening could also be located along the shaft or down in the scrotum.

What causes hypospadias?

Hypospadias is often associated with a bend (chordee) or twist (torque) of the penis, and an abnormal (described as ‘hooded’) foreskin.

Referral to a paediatric urologist is required in order to discuss surgery. Minor degrees of hypospadias may be of no functional consequence, and hence will not require surgery. In more severe cases, surgery is indicated to ensure the boy will be able to wee standing up, and that he has straight erections when he grows up.


Treatment for hypospadias

Hypospadias does not affect future continence or fertility. In most cases the repair may be performed as a day-case procedure under general anaesthetic, meaning your child will not be required to stay in hospital overnight, and can return home the same day as the procedure. More severe degrees of hypospadias will require a complex surgical repair in at least two stages, 6 months apart. Surgery is usually recommended from 9 months of age.

Penile chordee/torque or a hooded foreskin may be present without a hypospadias. In these cases, your paediatric urologist will advise you on management options.

Other penile abnomalies include penoscrotal tethering (or ‘webbed penis’), congenital megaprepuce (excessive layers of foreskin resulting in ballooning and urinary retention). Referral to a specialist is recommended in all cases.

If you are concerned about an abnormality in your child’s penis, make an appointment with a consultant paediatric urologist.

By Miss Marie-Klaire Farrugia
Paediatric urology

Miss Marie-Klaire Farrugia is a consultant paediatric urologist based at Chelsea and Westminster Hospital and the BUPA Cromwell hospital in central London. She specialises in all areas of kidney, bladder and genital anomalies that babies are born with or develop later in childhood. In particular, she counsels pregnant mothers whose babies are prenatally-diagnosed with a kidney condition, so that the best postnatal plan can be made for the newborn.

Miss Marie-Klaire Farrugia is the clinical lead for paediatric surgery in the North West London Network, and writes guidelines and teaches in the major North West London hospitals. Her research interests include the long-term outcome of prenatally-diagnosed urological problems such as hydronephrosis and posterior urethral valves and vesicoureteric reflux. She is an experienced open, laparoscopic and robotic surgeon and performs neonatal and childhood circumcision; repair of simple and complex hypospadias including staged graft repairs; hernia and hydrocoele repairs; surgery for undescended testes; pyeloplasty; ureteric reimplantation; surgery on duplex kidneys and ureterocoeles; posterior urethral valves; nephrectomy and hemi-nephrectomy; Deflux injection for kidney reflux with urine infections; amongst others.

Miss Farrugia is an executive member of the Society for Fetal Urology and a member of the British Association of Paediatric Urologists, the European Society for Paediatric Urology, the American Association of Pediatric Urologists and the Societies for Pediatric Urology.

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