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Updated: Dec 25 2021


  • Snapshot
    • A child is born with a urethral opening located between the tip of the glans penis and the base scrotum.
  • Introduction
    • Abnormality of anterior urethral and penile development
    • Urethral opening is ectopically located on the ventral side of the penis proximal to the tip of the glans penis
    • Urethral opening may be located in the scrotum or perineum
    • Position of the urethral meatus defines the type of hypospadia
    • Penis is more likely to have associated ventral shortening and curvature with more proximal defects
    • Caused by congenital defect during development of the urethra
    • May be associated with family history of the disorder or infertility treatment (IVF)
  • Presentation
    • Symptoms
      • urination follows path of malpositioned urethral meatus
    • Physical exam
      • meatal location between tip of the glans and perineum
      • glans configuration may be splayed open in distal cases
      • skin coverage deficits must be noted
      • chordee may be appreciated resulting in abnormal curvature of the penis
  • Differential
    • Ambiguous genitalia, genital anomalies, error in circumcision
    • Diagnosis is based on clinical observation alone
    • Family history
      • familial transmission may be identified
      • infertilty treatment should also be documented
        • IVF has been associated with a higher incidence of hypospadias
  • Treatment
    • Medical management
      • none
    • Surgical intervention
      • surgical repair
        • indicated in cases proximal (i.e. not adjacent to) from the glands penis
        • may not be indicated in less severe cases
        • multiple surgical approaches and methodology exist in the literature
        • usually performed before 1 year of age
  • Complications
    • Post-surgical complications, meatal stenosis, urethral strictures/diverticula, recurrent urinary tract infections, permanent phallic malformation
  • Prognosis
    • Ranges widely depending on location and severity of anatomic abnormality
    • Surgical outcomes range, but as surgical technique and microsurgery improves, future prognosis is expected to increase significantly
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