Hypospadias is a congenital anomaly of the male reproductive system, in which the opening of the urethra (urinary tract) is located on the underside of the penis instead of at the tip. This condition is usually recognized immediately after birth. A commonly observed external sign is the absence of foreskin on the front part of the penis.

Hypospadias affects approximately 1–3% of male infants, which corresponds to about 1 in every 250–300 boys. The incidence may vary depending on genetic and environmental factors. Despite this, it remains one of the most common surgical conditions pediatric surgeons encounter.

Hypospadias is classified according to the location of the urethral opening. When the urethral meatus is located just below the normal position, it is referred to as distal hypospadias. This type is more common and responds better to treatment. The further the opening is down the shaft of the penis, the more severe the hypospadias. In such cases, the risk of postoperative complications increases. Therefore, these children must undergo surgery at a specialized center experienced in hypospadias repair and continue regular follow-up. Additionally, a downward curvature of the penis (chordee) is frequently observed in children with hypospadias and must be corrected during surgery.

Symptoms

Common complaints from families include:

• The urethral opening is located on the underside of the penis or near the scrotum instead of at the tip

• A downward curvature of the penis

• Difficulty urinating

• Absence or underdevelopment of the foreskin

• Frequent urinary tract infections

Treatment

If left untreated or improperly managed, hypospadias may lead to urination problems, sexual dysfunction in adulthood, cosmetic concerns, and psychological issues.

The only treatment option is surgical repair, known as hypospadias repair. This surgery is usually performed when the child is between 6 and 24 months old. The ages of 2 to 6 years are considered a sensitive period during which children become more aware of their genitalia, so surgeries involving the penis—such as circumcision or hypospadias repair—should be avoided unless absolutely necessary.

The primary surgical goals are to correct the curvature, reposition the urethral opening to its normal location, and to achieve a cosmetically normal penis.
It is critical that children with hypospadias are not circumcised before surgical evaluation, as the foreskin is often essential for the repair, either during the procedure or as a tissue source in case of complications or future revisions.
Children evaluated early by a pediatric surgeon can typically undergo combined hypospadias repair and circumcision in a single procedure, thus avoiding unnecessary surgeries and reducing risks.

Complications

The most common complication after hypospadias surgery is the formation of a urethrocutaneous fistula, where urine leaks through a newly formed opening in the skin. This is more likely in proximal hypospadias, where the urethral opening is located closer to the scrotum.
In milder forms (distal hypospadias), the risk is significantly lower.

Other rare complications include:

• Urethral stricture (narrowing of the urethra)

• Surgical site infections

• Difficulty urinating

• Recurrent penile curvature

Surgical revision is often required to address these complications.

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