Hypospadias: An Overview
by Douglas J
Stated simply, hypospadias is a mislocation of the urinary opening, below the usual place on the tip of the penis in males, or when the bladder empties through the front vaginal wall in females. This is the end of the simple part, as hypospadias is one of the most variable of birth differences and is the most common birth difference in boys. The location of the opening can vary from just below the tip of the penis, to the most severe variety in which the bladder empties just forward of the rectum. Hypospadias occurs as a part of over 100 known genetic syndromes, and can be accompanied by other birth differences such as inguinal hernia and undecended testicles.
Chordee, a bending of the penis, is frequently a fundamental part of hypospadias, although it is possible for both conditions to occur without the other. Boys with hypospadias will often have a hooded foreskin, which is a foreskin that is incomplete on the bottom of the penis. Circumcision should not be performed on boys with hypospadias, as this hood romApproximately 60% of all cases involve an opening at the glans to shaft junction of the penis, and become increasingly less common as the opening moves back. In approximately one quarter of cases openings will occur on the shaft of the penis behind the glans, and about 15% of cases feature the opening in the scrotum or farther back.
Hypospadias is a term some specialists prefer to reserve to describe the male condition; in females, vesico-vaginal fistula (a passage from the bladder to the vagina) is the preferred diagnosis. In rare cases, this passage is the urethra. Diagnosis would depend on whether there is a normally located native urethra in addition to the fistula, the presence of which would exclude hypospadias. Girls with fistulae or hypospadias will urinate from the vagina, often with discomfort due to the irritating properties of urine. Children of both genders may have frequent or recurring urinary tract infections and in these cases follow-up investigation is often indicated to determine if urinary tract anomalies exist, or if reflux is present at the kidneys.
Hypospadias can occur in generations of families in a classic hereditary pattern and also as isolated cases. Most hypospadias is isolated, so while it can be passed down, it is not necessary to have a relative with hypospadias for there to be a possibility it will occur. Estimates are that there is an 8% increased risk of hypospadias if the father is affected, and 12% increased risk if an older sibling is also hypospadic. Please note that this is NOT an 8 or 12 percent risk of hypospadias in any random birth. It is an estimate of the increase in the overall background risk of bearing a child with hypospadias.
Overall estimates of the rate of occurence of hypospadias range from 1 in 300, to 1 in 125 live births, and like any other human demographic, the numbers change by location, accuracy of record keeping, consistency in classification of the difference and so on. While there is some difference in rates by race, the differences are not statistically significant. Hypospadias occurs in all races and ethnicities. Some researchers have concluded that hypospadias is increasing. Others have not reached that conclusion, pointing to inconsistent reporting of hypospadias in the past, and natural fluctuations in annual statistics.
Some things we don't know about hypospadias:
- There is a lot of internet content on pesticides, pthalates, phytoestrogens, DES, prescription drugs, industrial pollution and so on, and the hypothetical effects on birth defects. While we do know that certain prescription drugs can cause hypospadias, the links between hypospadias and other substances in the environment have not been proven. At this time, there is no proven single cause for hypospadias, and since hypospadias is highly variable in form and occurence, it is likely that it is caused by multiple factors.
by an HEA Member
Hypospadias (HS), what is it and what does it mean to an individual born with the condition?
Having been born with HS at a time before the internet, it was a condition that did not have a name in my case until I was in my twenties. Thinking it was just me with the condition, I never went to the reference library to research it and my parents, sibling, doctor, etc. never brought up the subject.
There are various forms of hypospadias from mild, where the meatus (outlet of the urethra where the urine and semen come out) is on the glans, through more severe where the opening is on the shaft of the penis, to quite severe where the opening can be between the scrotum and anus. All the variation may have chordee, which is a bend in the penis, and this may cause problems when the penis is erect so that sexual penetration may be difficult. With HS there may also be a hooded foreskin which covers half of the glans; this tissue may be used in any subsequent surgical procedure.
It may be that a severe case of HS needs some surgical procedure to try to improve the chordee and/or bring the meatus nearer the tip of the penis. There can be some failures in these procedures; strictures (a narrowing of the urethra) in the newly formed urethra or a fistula (an extra hole through which urine leaks out) in the scar line may present. Mild cases may be left as they are at birth since the functions of the penis are working well.
There is the psychological aspect to consider, however, since the male individual tends to be aware of his penis from an early age. Inevitably there will be comparisons made at school or in showering after sport and just how informed the individual was made at home may well help to cope with this situation. In other words, the young person should be aware that he is not alone in this HS business and need not be ashamed of his differently-shaped penis.
I would say that two or three young adults with HS have recently told me that they have made immediate friends with people at school, both male and female, who are aware of their HS. These people have been treated with respect and understanding. This is something I did not dare do as a young adult but just shows that knowledge, and the proper use of it, can be a great help in coming to terms with hypospadias.