Hypospadias and Chordee

Hypospadias

Hypospadias is a common birth defect of the penis where the urethra (the tube that carries urine from the bladder to outside of the body) is not at the tip of the penis. It can be located anywhere on the undersurface of the penis to the scrotum.

A condition called chordee is often seen with hypospadias. Chordee is an abnormal downward curve of the penis. This can occur with or without a hypospadias. 

Classification of hypospadias is done by the position of the urethral opening. The types of hypospadias include:

  • Distal or glanular:  most common form when opening is found near the head of the penis
  • Midshaft:  when opening is found in the middle to the lower shaft of the penis
  • Penoscrotal:  when  opening is on the scrotum
  • Perineal: when opening is behind the scrotal sac. These are the most severe forms of hypospadias.

Genetics, the environment and hormones may be factors that influence the development of this defect.

Usually, hypospadias is noticed at birth. Along with the misplaced opening, the foreskin is often incomplete and forms a hood. This is called a dorsal hood. However, some newborn boys have abnormal foreskin with a normal positioned urethral opening.

During the ninth to 12th week of fetal (unborn child) development, the urethral opening does not completely form at the tip of the penis. This occurs in one out of every 150 to 300 boys. There is a family tendency that if one boy has hypospadias, another son has a 15 percent chance of having the condition. Eight percent of fathers who have a son with hypospadias also had the condition.

If a hypospadias or chordee deformity is not repaired, your child may have these issues as he grows:

  • His urine stream may be hard  to direct and control
  • The penis may curve as he grows causing sexual dysfunction later in life
  • If the urethral opening is near or behind the scrotum, he may have fertility problems later in life

No medicine will correct a chordee or hypospadias, and the child will not outgrow these conditions. Surgery is recommended and is almost always successful when performed by an experienced pediatric urologist.

The goals of surgery are:

  • To bring the urethral opening to the tip of the penis to allow a controlled stream of urine while standing
  • To straighten the penis, if a chordee is present, therefore allowing an unrestricted erection
  • To improve the appearance of the penis
  • To deter fertility issues later in life

At birth, your child will not be able to undergo a circumcision because the foreskin may need to be used for the surgical repair.  Doctors prefer to perform the hypospadias surgery between 6 -24 months of age. However, the surgery can be done at a later age.

The surgery is usually done on an outpatient basis.  This repair may need to be done in multiple stages.  Most hypospadias surgeries create a penis that functions well and looks very near normal.

Surgery for Hypospadias

The surgery is done while the patient is asleep, under general anesthesia. Sometimes, the surgeon may prefer that the child not urinate through the repaired urethra during the first few days. A small plastic tube, called a catheter, is anchored to the head of the penis with stitches. This allows the urine to flow out without coming into contact with the repair. This tube is removed in seven to 14 days in the office without causing the patient much discomfort.

A dressing is wrapped around the shaft of the penis at the end of the surgery. This will help hold down the swelling and make your child more comfortable. Remove this dressing if your child doesn't urinate within eight hours or if it rolls down and starts to tighten around the penis.

Your child will get antibiotics (medicine that will kill bacteria) and may get a medicine to stop bladder spasms.

Hypospadias surgery is very successful, but there are some potential complications. In some instances, a hole or a fistula may occur and urine may leak through the hole. The urethra would need more surgery to repair this. Scarring within the urethra may occur and cause the urethra to narrow. This may interfere with the passage of urine and would also need to be corrected with surgery. Most complications are easy to repair with additional procedures.

Patients may need to return for checkups until after puberty.

  • Your child can't urinate (pee) or has trouble urinating
  • Your child has severe pain or bladder spasms that can't be controlled with medicine
  • Your child has a fever of 101° or higher during the week after surgery
  • Your child has vomited more than three times and can't keep liquids down
  • The blue stitches in your child's stent (tube) become dislodged or fall out

Last Updated 06/2013