Discovering that your baby boy has hypospadias can be worrying for parents. Many questions naturally follow: Is it serious? Will he need surgery? Will it affect him later in life?

The good news is that hypospadias is a common congenital condition that can usually be treated successfully. With appropriate evaluation and, when required, timely surgical correction, most children can grow up to lead completely normal lives

But first, what is hypospadias?

Hypospadias is a condition present from birth in which the opening through which urine comes out, the urethral opening, is located somewhere along the underside of the penis rather than at its usual position at the tip.

The position of the opening can vary considerably. In some children it is only slightly lower than usual, while in others it may be located further down the shaft or closer to the base of the penis.

Hypospadias may also be associated with:

• A downward curvature of the penis
• A hooded or incomplete foreskin
• An unusual urinary stream
• Difficulty directing urine while standing, particularly in older children
• Undescended testis
• Disorders of Sexual Development

The severity varies from child to child, which is why an individual assessment by a pediatric surgeon or pediatric urologist is important.

What causes hypospadias?

In most children, the exact cause of hypospadias is not known.

The penis develops during pregnancy, and hypospadias occurs when the urethra does not completely form and close in its usual position.

It is not caused by anything parents did during pregnancy.

Some genetic, hormonal and environmental factors may contribute, but in many children there is no identifiable reason.

How is hypospadias diagnosed?

Hypospadias is usually diagnosed during the newborn examination.

The pediatric surgeon will assess:

• The location of the urinary opening
• The shape and development of the penis
• Whether there is any curvature
• The foreskin
• The position and development of the testicles

In most children, the diagnosis can be made through a physical examination.

If hypospadias is associated with other genital abnormalities, the doctor may recommend additional investigations.

Does every child with hypospadias need surgery?

Not necessarily.

The decision depends on the position of the urethral opening, the degree of curvature and the child’s overall anatomy.

Mild forms may have little or no functional impact. In other children, surgery may be recommended to:

• Create a urethral opening in a more appropriate position
• Correct significant curvature
• Improve urinary function
• Improve the appearance of the penis
• Help the child urinate comfortably while standing

The treatment plan should therefore be individualized rather than based only on the diagnosis of hypospadias.

What is hypospadias surgery?

Hypospadias surgery aims to reconstruct the urethra and, when necessary, straighten the penis.

The exact technique depends on the type and severity of hypospadias.

In some children, the repair can be completed in a single procedure. More complex cases may require staged reconstruction.

The procedure is performed under general anaesthesia. Depending on the repair, a small urinary catheter or stent may be used temporarily while the reconstructed urethra heals.

Your surgeon will explain the planned procedure, expected recovery and aftercare before surgery.

What is the best age for hypospadias surgery?

The appropriate timing depends on the individual child and the severity of the condition.

Many repairs are performed during early childhood, when the child is still young and before issues around body image or urination while standing become significant.

However, there is no single age that is right for every child.

A pediatric surgeon will consider your child’s anatomy, overall health and the type of repair required when recommending timing.

What happens after surgery?

Your child may experience some swelling or discomfort after the procedure. Pain medicines prescribed by the surgical team can help keep him comfortable.

Parents may be asked to:

• Keep the surgical area clean
• Give prescribed medicines as directed
• Care for the dressing or catheter
• Encourage fluids, where appropriate
• Attend scheduled follow-up appointments

The surgical team will explain when normal activities, bathing and school can be resumed.

Can hypospadias come back?

Hypospadias itself does not “come back” after a successful repair. However, as with any reconstructive surgery, complications can occasionally occur.

These may include narrowing of the urinary opening, a fistula or problems with healing.

Regular follow-up allows the surgeon to identify and manage any concerns early.

When should parents see a pediatric surgeon?

If your newborn has been diagnosed with hypospadias, an early consultation is useful even if surgery is not immediately planned.

Parents should seek specialist assessment particularly if:

• The urinary opening is significantly away from the tip
• The penis appears noticeably curved
• The child has difficulty with urination
• The testicles are not in the scrotum
• You are unsure whether circumcision should be performed

Consulting an experienced pediatric surgeon in Mumbai can help parents understand the severity of hypospadias, whether further investigations are needed and when treatment should be considered.

An important point about circumcision

If a baby is diagnosed with hypospadias, do not proceed with routine circumcision before consulting a pediatric surgeon.

The foreskin may sometimes be useful during reconstructive surgery.

Frequently Asked Questions

Is hypospadias painful?

Hypospadias itself is usually not painful. The main concerns relate to the position of the urinary opening, penile curvature and, in some children, urinary function.

Can hypospadias affect fertility?

Most boys with appropriately treated hypospadias can have normal sexual and reproductive function later in life. The impact depends on the severity and whether other genital abnormalities are present.

Will my child be able to urinate normally?

The goal of surgery, when required, is to create a functional urethra and allow comfortable urination.

Is hypospadias a serious condition?

The severity varies widely. Mild hypospadias may have little functional impact, while more complex forms require specialist treatment.

Will my child need more than one surgery?

Many children require only one procedure, but more complex hypospadias may require staged surgery. The surgical plan depends on the individual anatomy.

The right treatment begins with the right evaluation

A diagnosis of hypospadias can be overwhelming for parents, but it is a condition that pediatric surgeons manage regularly.

The most important step is understanding your child’s specific anatomy and what treatment, if any, is appropriate.

If your child has been diagnosed with hypospadias, consult a pediatric surgeon experienced in pediatric urological and reconstructive surgery for an individualized assessment. Parents searching for a pediatric urologist in Mumbai can seek an expert consultation to discuss their child’s diagnosis, treatment options and follow-up requirements.

Dr. Jui Mandke is a Pediatric & Neonatal Surgeon and Pediatric Laparoscopic Surgeon with expertise in pediatric urological conditions and reconstructive procedures.