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Hypospadias is a congenital abnormality of the penis in which the urethral opening is positioned either along the shaft of the penis on its underside or on the scrotum or perineum instead of being located at the tip of the penis. With increasing degrees of severity, the penis is curved downward (referred to as chordee).
This is a relatively common condition, historically occurring in about 1 per 300 to 500 live male births. The incidence and severity of hypospadias has doubled in the United States over the last 25 years. This increase is believed to stem from environmental pollution with substances (chiefly insecticides) that have either estrogen-like effects or testosterone-blocking effects. Overall, the incidence is now believed to be about 1 in 100 male babies.
Most commonly, the urethral opening (meatus) is located on the glans of the penis. This frequently does not necessitate treatment except for cosmetic purposes, but the psychological impact of being "different" from the other boys in the restroom at school should be of great concern.
The less common but more severe forms of hypospadias, in which the urethral opening is located on the penile shaft or in the perineum, may interfere with normal urination in the usual male standing position and may interfere with fertility. These more severe cases are usually corrected early in childhood to avoid social embarrassment and psychologic trauma. The ideal age for repair is before the age of 18 months. Routine newborn circumcision should be avoided, as the foreskin is often essential for repair later in life.
Testicles are undescended in 10% of boys with hypospadias. Inguinal hernias are also common. Newborns with hypospadias and undescended testicles should be evaluated for the possibility of hormonal abnormalities.
The incidence of other abnormalities of the genitourinary tract in boys with hypospadias is low, and with the probable exception of the most severe cases of hypospadias, xray studies of the urinary tract are usually not justified.