Hypospadias / Chordee

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 this structural difference.

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 uncommon 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. Hypospadias 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.

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

No medicine will correct a chordee or hypospadias, and the child will not outgrow these conditions. Surgery may be recommended and surgical outcomes are improved when performed by an experienced pediatric urologist.

The goals of the 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) to minimize the risk of painful intercourse  

At birth, it is not recommended your child undergo a circumcision because the foreskin may need to be used for the surgical repair. A pediatric urologist may recommend 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.  In more severe forms of hypospadias surgical repair may need to be done in multiple stages.  Most hypospadias surgeries may create a penis that functions well for urinary and sexual purposes.

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 reduce the expected swelling and make your child more comfortable.

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

Hypospadias surgery may be very successful, but there are some potential complications. In some cases, 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.

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