Hypospadias unveiled: A comprehensive guide

Written by: Mr Nav Johal
Edited by: Kate Forristal

In his latest online article, Mr Nav Johal gives us his insights into hypospadias. He talks about what it is, how common it is, the symptoms, diagnosis, treatment, when surgery is recommended, potential complications or risks, if it can affect fertility or sexual function and the long-term outcomes.   

What is hypospadias, and how common is it? 

Hypospadias is a congenital condition characterised by the atypical placement of the opening of the urethra, which is situated on the underside of the penis rather than at the tip. This condition occurs during fetal development when the urethral tube, responsible for carrying urine from the bladder to the outside of the body, does not fully close during the first trimester of pregnancy. Hypospadias is relatively common, affecting approximately 1 in every 200 to 300 male births. The severity of the condition can vary, with some cases being milder and others requiring surgical correction.      


What are the symptoms of hypospadias, and how is it diagnosed?  

Symptoms of hypospadias often include a noticeable displacement of the urethral opening, typically on the underside of the penis, along with a curvature of the penis. In more severe cases, individuals may experience difficulties with urination.    


Diagnosis of hypospadias is usually made shortly after birth through a physical examination conducted by a healthcare professional. The distinct positioning of the urethral opening during this examination allows for a prompt and accurate diagnosis.      


How is hypospadias treated, and when is surgery recommended?  

The primary treatment for hypospadias involves surgical correction to reposition the urethral opening to the tip of the penis. The decision on when to perform the surgery depends on the severity of the condition. In some instances, surgical intervention may take place in early infancy to address the anomaly, while in other cases, it might be delayed until the child is older. The timing of the surgery is carefully considered to optimise outcomes and minimise potential complications.      


Are there potential complications or risks associated with hypospadias surgery?  

As with any surgical procedure, hypospadias repair comes with potential risks and complications. These can include bleeding, infection, or issues related to the cosmetic appearance of the penis. It is crucial for parents and guardians to engage in thorough discussions with healthcare providers to fully understand the potential risks and benefits associated with the surgery. This informed decision-making process is vital in ensuring the best possible outcome for the child.    


Can hypospadias affect fertility or sexual function later in life?  

While the primary goal of surgical correction is to restore normal anatomy, concerns may arise about fertility and sexual function as individuals with hypospadias reach adulthood. In most cases, successful surgical intervention minimally affects fertility and sexual function.    


What are the long-term outcomes for individuals with hypospadias, and is follow-up care necessary?  

Long-term outcomes for individuals who undergo hypospadias surgery are generally positive. Successful surgical correction often leads to normal urination and an improved cosmetic appearance of the penis. Despite this, follow-up care is crucial to monitor the individual's progress and address any potential issues that may arise post-surgery. Regular check-ups with healthcare providers help ensure that the patient is developing appropriately and that there are no complications or recurrence of the condition.   


Mr Nav Johal is an esteemed consultant paediatric urologist with more than 25 years if experience. You can schedule an appointment with Mr Johal on his Top Doctors profile.  

By Mr Nav Johal
Paediatric urology

Mr Nav Johal is a leading consultant paediatric urologist based at Great Ormond Street Hospital for Children and covers all areas of general paediatric urology including hydronephrosis, hypospadias, undescended testes, foreskin problems, urinary tract infections and vesicureteric reflux. Additionally he counsels parents born with prenatally diagnosed conditions affecting the kidney, bladder and genital anomalies.

Mr Johal obtained his primary medical qualification from Cardiff University and was appointed member of the Royal College of Surgeons in 2003. He was additionally awarded a PhD in 2013 on congenital bladder anomalies from University College London. He completed several fellowships in specialised areas of paediatric urology at the internationally renowned Great Ormond Street Hospital as well as the Royal Marsden Hospital in bladder reconstruction. He was made a fellow of the Royal College of Surgeons in 2014 and has been based at Great Ormond Street as a consultant paediatric urologist since 2017. Additionally, he holds the position of clinical lead of service at University College Hospitals London NHS Foundation Trust and is also a member of their prenatal nephro-urology counselling team.

Mr Johal is actively involved in research and has been previously been awarded numerous research fellowships. He is currently honorary associate professor at the Great Ormond Street Institute of Child Health and University College London. His academic work has been widely published in scientific journals and medical textbooks.

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