Hypospadias (hypo-spay-dius) is an abnormality of the penis. It affects about one in 150 male babies, and is usually detected at birth. 

The urethra is a tube connecting the bladder to the tip of the penis, carrying urine (wee) outside of the body. When hypospadias occurs, the end of this tube does not form properly and the urine can come out in the wrong place.

In most cases, the foreskin is also underdeveloped and an abnormal curvature of the penis can occur. This can affect self-esteem and sexual function in the future.

Unless it is very mild, hypospadias usually requires surgery.

Signs and symptoms of hypospadias

There are different types of hypospadias, depending on the symptoms. Signs that your child has hypospadias include:

• The opening of the urethra (where the urine comes from) is not at the end of the penis but is somewhere else along the penis (see the diagram below).
• The foreskin may be all at the top of the penis (dorsal hood) and there may be none on the under surface.
• The penis may not be straight (it has a bend in it) – this is called a chordee.
• There is not a straight stream of urine.

While hypospadias is usually detected at birth, in some instances it is not picked up for several years. If you are concerned about your child's penis, see a GP.

Some cases of hypospadias are also associated with undescended testicles (see our fact sheet Undescended testes).

Treatment for hypospadias

The treatment options depend on how severe the hypospadias is. Sometimes your child's urinary tract will need to be investigated to make sure that there are no other problems, especially when the abnormality is more severe.

Unless very mild, hypospadias is usually corrected by surgery to:

• move the hole (urethral opening) to the tip of the penis, and close over the hole that was previously there – this will enable your child to urinate standing up and with a straight stream of urine  
• correct the bend so that the penis is straight and make the penis look normal.

The age for correction is from six to 18 months of age, depending on a number of factors. You will need to discuss this with your child's surgeon. More than one operation may be required.

It is not advisable for your child to be circumcised before surgery. The foreskin may need to be used in the operation. If this is the case, the penis can be made to look circumcised after the surgery if you choose.

Risks and side effects of surgery

As with all surgery, there are some risks and potential side effects involved. These are rare, and the benefits of surgery will outweigh the risks. Some complications specific to hypospadias surgery include: 

• Most children will need a catheter or stent for about a week after the surgery. A side effect from some catheters is bladder spasms. Medication is available to help stop the spasms if they occur.
• There may be some bleeding from the penis.
• The wound may not heal well. Either part, or rarely all, of the wound could breakdown. Urine may then leak out of the original hole. This is called a fistula.
• The new opening may narrow, which makes it more difficult to pass urine. This is called a stricture.
• There may be incomplete correction of the bend.

Surgery to correct hypospadias should be only done by an experienced paediatric urologist (a doctor who specialises in urinary-tract systems).

Care in hospital after surgery

• Your child will have clear fluids going directly into a vein through a drip (intravenous or IV therapy) until they are ready to eat and drink again. 
• If antibiotics are needed, these will be given through the drip. Your child may need to keep taking antibiotics by mouth at home.
• Your child will be given regular pain relief.
• There may be a dressing around the penis. If a dressing is used, your doctor will tell you when this can come off.

How long your child needs to stay in hospital will depend on:

• the type of hypospadias they have
• how quickly they recover from the operation
• how comfortable you are to take them home with a catheter, if they have one.

The hospital staff (doctors, nurses and specialists) will teach you how to look after the catheter at home. Make sure you understand the instructions before you go home. Ask for clarification if you are not sure.

Care at home

• Put Vaseline in your child's nappy, or on a pad in their underpants, to stop the penis sticking to nappies or clothing. The nurses will advise you how to do this. 
• Encourage your child to drink plenty of fluids. This helps them to wee often, which is important.
• Give pain relief when needed. Paracetamol may be enough. See our fact sheet Pain relief for children.
• Give oral antibiotics as instructed.
• Follow instructions from the doctor about the dressing on the penis. The doctor will tell you when it needs to be soaked off.
• Make sure that your child doesn't do vigorous activities until advised that it's OK by the doctor.
• Add two tablespoons of cooking salt to your child's bath water to help reduce swelling once your child's doctor has advised that your child can have a bath.

Contact your doctor or treating hospital if:

• you cannot manage or control your child's pain
• your child has a temperature over 38.5ºC
• the wound becomes infected (looks red, inflamed or is oozing)
• your child is not passing enough urine – the wee will become very dark in colour if this happens
• you have any concerns about the catheter, or it comes out before it is due to be removed
• the dressing falls off before the due time
• you are worried at all.

Key points to remember

• Hypospadias is an abnormality of the penis in which the opening of the urethra is not at the end of the penis. 
• Unless very mild, hypospadias is usually corrected by surgery.
• Surgery should be only done by an experienced paediatric urologist.
• The amount of time spent in hospital will depend on your child's recovery, and how comfortable you are caring at home for a catheter, if required.

For more information

• Kids Health Info fact sheet: Undescended testes
• Kids Health Info fact sheet: Pain relief for children.
• Urology Care Foundation: Hypospadias

Call an ambulance (000) immediately in an emergency.

Developed by The Royal Children's Hospital Urology and Paediatric and Neonatal Surgery departments. We acknowledge the input of RCH consumers and carers.

Reviewed May 2018.

This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.