Hypospadias / Chordee

Hypospadias occurs in one out of every 150-300 boys. If a boy has hypospadias, there is a 15 percent chance that his brother will have the condition. Eight percent of fathers who have a son with hypospadias also have the condition.

The exact cause of hypospadias is unknown. There are many factors believed to be involved in its development. Genetics, the environment and hormones may be factors that influence the development of hypospadias.

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

Some boys with mild forms of hypospadias can have no symptoms from their hypospadias.

If the hypospadias and/or chordee 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.

Some patients with hypospadias do not undergo any treatment besides observation, due to no symptoms or patient / family preference. Surgical treatment of hypospadias and chordee can change the appearance of the penis and is desired by some patient / families after discussion with their doctor.

No medicine will correct a chordee or hypospadias, and the child is not expected to outgrow these anatomical conditions.

Surgery can often correct hypospadias. The care team may recommend surgery to:

• Bring the urethral opening to the tip of the penis. This allows a controlled stream of urine while standing.
• Straighten the penis (if chordee is present) to minimize the risk of painful intercourse later in life.

A pediatric urologist may need to use the foreskin as part of the surgical repair, so these children are not recommended to have a circumcision at birth. Surgical repair usually takes place after 4 to 6 months of age, however it can be done later.

The surgery is usually done on an outpatient basis while the patient is asleep, under general anesthesia. In the more severe forms of hypospadias, the surgical repair may be done in multiple stages.

Hypospadias surgery may be very successful, but there can be some potential complications. In some cases, a hole or a fistula may occur, and urine may leak through the hole. More surgery may be needed to repair this problem.

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.

Patients may need to return for check-ups until after puberty.