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Hypospadias is a birth defect or congenital condition in boys where the opening of the urethra doesn't line up or end up at the tip of the penis. The penis is the outlet from where urine and sperm are released from the body, and this misalignment occurs between the eighth week and 14th week of pregnancy.

Although it is considered to be a rare phenomenon, the occurrence of this pediatric urological disorder has been increasing over the years. The incidence of hypospadias used to be about one in every 250 newborn boys earlier; it has increased to one out of every 150 newborn boys according to more recent studies on the subject in India.

The abnormality of this misaligned opening can be from just below the penis all the way down to the scrotum, and is clinically described by a few different types. Under normal circumstances, the opening of the urethra is located within the head of the penis.

Here is how it happens: It is between the eighth and 14th weeks of pregnancy that the sex development of the baby is taking place inside the womb of the mother, as the sexual organs look similar until then. It is only during this period when the male hormones are produced by the testes - such as testosterone and Dihyodrotestosterone - that the sexual organs start developing into pronounced male organs. 

This complex phenomenon taking place inside the womb through the production of hormones is what gives the penis its final shape and the urethra develops simultaneously, to line up with the opening of the penis. Any shortage in the production of hormone levels that are needed for this development can result in the occurrence of hypospadias, as the urethra doesn't end up at the tip (glans) of the penis.

In some cases, hypospadias are also clinically related or occur together with undescended testicles, or result in low sperm count, or even testicular cancer later in life. In recent years, the prevalence of hypospadias has increased to about one in 126 newborn boys in the country, while the occurrence of undescended testicles is even more at a rate of about 5%.

Some boys with hypospadias may have curved penises as a result, and it can have more complications later in life such as unusual spraying of urine, sometimes to the extent that they may have to sit down to urinate. However, it is one of the more common birth defects in newborn boys, and early treatment is recommended to avoid problems later in life.

  1. Types of Hypospadias
  2. Hypospadias Symptoms
  3. Hypospadias Causes and Risk Factors
  4. Prevention of Hypospadias
  5. Diagnosis of Hypospadias
  6. Hypospadias Treatment
  7. Hypospadias Complications

Types of Hypospadias

Hypospadias can be of varying degrees and severity, and is generally identified by the location of the opening of the urethra:

  • Subcoronal: The opening of the urethra is located near the head of the penis
  • Midshaft: If the opening of the urethra is located somewhere along the shaft of the penis
  • Penoscrotal: The opening of the urethra isn't even anywhere on the length of the penis, but is instead located between the penis and the scrotum.

Hypospadias Symptoms

The symptoms can be quite tell-tale in the case of hypospadias as most of the signs are visible, although they can be different based on the nature of the case in each child:

  • The opening of the urethra is not at the tip of the penis
  • Abnormal spraying is experienced while urinating
  • There is a downward curve in the shape of the penis, also referred to as chordee
  • The top half of the penis is covered by the foreskin, giving it a hooded appearance

Hypospadias Causes and Risk Factors

While definitive causes are unknown in the occurrence of hypospadias, there are certain factors that contribute to this development in the womb of the mother:

  • Genetic factors: If the newborn boy's father or brother were born with it, there are chances of certain genetic factors at play in the development of hypospadias.
  • Mother's age and health: There is a higher likelihood of hypospadias in the newborn boy if the mother conceived after the age of 35, has diabetes or is overweight during or before pregnancy. (Read more: Obesity)
  • Fertility treatments: More and more people around the world have been looking at fertility treatments, and certain treatments such as hormone therapies or certain medications may be contributing factors towards the development of hypospadias in their newborn boy.
  • Smoking: The habit of smoking, or having ingested pesticides or harmful chemicals have also been linked with mothers giving birth to boys who have this condition. (Read more: Harmful effects of smoking)
  • Premature birth: In some cases, premature deliveries also have a likelihood of the boy being born with hypospadias.

Prevention of Hypospadias

As the condition of hypospadias develops over time and in the womb of the mother, there are certain precautions you can take when you are pregnant:

  • Maintain a healthy body weight.
  • Avoid smoking and drinking alcohol while you are pregnant.
  • Take small doses of folic acid every day (between 400 to 800 micrograms). Studies have suggested that consuming folic acid during pregnancy has led to a reduced risk of hypospadias in newborn boys.
  • Make regular visits to the doctor to keep abreast of your pregnancy journey.

Diagnosis of Hypospadias

Hypospadias is an easy condition to diagnose, as most symptoms are visible in the newborn. Doctors are able to identify hypospadias while performing a routine physical examination right after birth. If not diagnosed after birth, hypospadias can be identified by the downward curved shape of the penis or chordee.

Hypospadias Treatment

Hypospadias that occur with the opening of the urethra close to the tip of the penis may not even need a corrective surgery to be performed, as there may not be any symptoms or discomfort being experienced by the child. In other cases, however, a surgery is done between the ages of 3 and 18 months, which involves repositioning the urethra to the glans of the penis, or straightening the shaft of the penis. There aren't any medications that can treat this condition which is a physical abnormality.

Hypospadias Complications

Doctors recommend getting the boy treated for hypospadias early as there can be complications that can arise out of this condition later in life. The curved shape of the penis may result in painful sexual intercourse, while the abnormal spraying of urine can worsen with age as well.

Although the surgical method to correct this misalignment is highly successful, there can be complications much like any other surgical procedure. In rare circumstances, there may be the occurrence of a fistula or a hole which may result in urine leaking out of it. There are also cases of scarring that may appear and lead to the narrowing of the opening of the urethra, which may again lead to discomfort while passing urine. However, both these complications can also be corrected through surgery.

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