Hypospadias is a congenital anomaly defined as a malformation of the male urethra, abnormally placed on the lower part of the glans penis, on the lower side of the penis or on the joint of the penis with the scrotum. Generally, hypospadias is also associated with a malformation of the foreskin -which normally does not fully develop itself- and a curvature of the penis towards the belly (congenital penile curvature).

Severe hypospadias

There are different types of hypospadias, depending on where the urethral opening is located; the further from the glans penis, the higher its gravity.

Because of that penile curvature, this malformation is considered as a cause of sexual dysfunction since it may impede mechanically the sexual act, and due to the abnormal position of the urethral opening, it may impede the ejaculation in the vagina.

It is a common anomaly in men, and its appearance frequency is estimated in around 1 and 8 newborn children out of 1000. Hypospadias has both aesthetic and functional consequences, and once the child has grown up, the consequences may be even psychological.

The position of the urinary meatus prevents the child from urinate standing up, and if the opening is too narrow urinating can present difficulties.

Hypospadias may sometimes go together with other types of malformations that may compromise the male fertility like the cryptorchidism or presence of hidden testicles; diagnosis of sexual ambiguity or pseudohermaphroditism must even be taken into account.

Causes

This malformation is under dependency of the androgens; thus, among the causes that originate it, a genetic mutation originating a deficiency in the androgen receptors may be involved.

This mutation may be inherited in some cases, and that is why it is believed that there is a certain genetic predisposition when there is a member of the family already suffering hypospadias. It is estimated that it is a 20% more likely to appear in other members of the same family.

It is also believed that the perturbation of the androgen embryonic receptors by environmental factors can be one of the responsible ones, as well as some type of hormone treatment during the first month or trimester of pregnancy or some type of alteration in the synthesis of testosterone.

Types

  • Posterior hypospadias: This type of hypospadias is the severest, and it occurs in a 20% of the cases. The urethral opening is located very distal from the glans penis, in the area where the scrotum is joined with the penis or in the base of the penis. This type of hypospadias goes together with a very curved penis.
  • Middle hypospadias: It occurs in a 10% of the cases, and presents a medium gravity. Here the opening is found on the middle part of the penis, normally on the lower side, causing a certain curvature of the penis towards the belly.
  • Anterior hypospadias: It is the most frequent case of hypospadias –a 70% of the cases- and the mildest one. In this type, the urinary meatus is located near the glans penis and the penis seems aesthetically normal, almost non-curved.

Treatment

The treatment to be chosen is surgical. Due to the psychological impact that this anomaly can cause on the child, it is recommended to operate at an early age, normally before the child turns 3, when they are between 6 and 24 months old.

A micropenis may develop due to the curvature suffered by the penis towards the belly. In the operation such curvature can be corrected, as well as reconstruct surgically the urethra and foreskin, if necessary. Sometimes the growth of the penis can also be stimulated by using hormone treatment.

Surgical tratment for hypospadias

There are different surgical techniques to solve the problem; the specialist will analyse the case and decide the most appropriate technique to deal with the different aspects involved, opening, curvature of the penis and foreskin.

Normally, if the problem is corrected in the childhood, there is not reason for consequences to appear in the adulthood.

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