Hypospadias

Hypospadias is a condition where the opening of the urethra (tube that carries urine from the bladder to the outside of the body) is not located at the tip of the penis. Often the foreskin is not fully developed on the underside of the penis and the end of the penis may be curved downward. The direction of the urinary stream may look abnormal as well. Hypospadias does not cause pain.

In hypospadias, the opening of the urethra can be located anywhere along the underside of the penis, from the scrotum (the most severe kind) to the tip (the least severe type)
Hypospadias mainly affects male newborns
It occurs in about 3 in 1,000 male births
Some studies have shown fathers of males with hypospadias also had hypospadias
Some newborn boys who have other congenital abnormalities such as undescended testes or inguinal hernias may also have hypospadias

How should I initially evaluate and manage my patient?

Initial Evaluation: A physician or healthcare professional usually diagnoses hypospadias at birth by physical exam.

Anterior (distal): hypospadias in the mildest form; occurs in 50 percent of cases.
Middle: moderate hypospadias; occurs in 30 percent of cases.
Posterior (proximal): most severe hypospadias; occurs in 20 percent of cases.

Initial Management:

If the infant is born with hypospadias and undescended testis, consider this a manifestation of congenital adrenal hyperplasia which is an endocrine emergency. That infant should be evaluated with a standard chemistry panel and perhaps referred to the nearest emergency department for evaluation of adrenal crisis.