Hypospadias is a congenital abnormality of the penis which occurs in approximately 3/1,000 male infants. There appears to be a significant genetic element, with further male children having a risk of around 5-15%.

It is usually identified on the newborn baby check. If missed, parents may notice an abnormal urine stream.

Hypospadias most commonly occurs as an isolated disorder. However, associated conditions include cryptorchidism (present in 10%) and inguinal hernia.

Hypospadias is characterised by

• a ventral urethral meatus
• a hooded prepuce
• chordee (ventral curvature of the penis) in more severe forms
• the urethral meatus may open more proximally in the more severe variants. However, 75% of the openings are distally located.

Management

• once hypospadias has been identified, infants should be referred to specialist services
• corrective surgery is typically performed when the child is around 12 months of age
• it is essential that the child is not circumcised prior to the surgery as the foreskin may be used in the corrective procedure
• in boys with very distal disease, no treatment may be needed.