Hypospadias
Hypospadias is a congenital ventral ectopic urethral meatus with a triad of features (proximal meatus, ventral curvature/chordee, and a dorsal hooded foreskin) — it is corrected surgically in infancy, and the foreskin must NOT be circumcised because it may be needed for reconstruction.
The big picture
Hypospadias results from incomplete development of the ventral urethra, so the meatus opens on the ventral penis anywhere from glanular to perineal. The classic triad is a ventrally displaced (proximal) meatus, ventral curvature of the penis (chordee), and a dorsally hooded (incomplete ventral) foreskin. Severity ranges from distal (most common, mild) to proximal (more complex). Associated findings (especially with proximal hypospadias and undescended testes) may prompt evaluation for a disorder of sex development.
Recognise the triad, do NOT circumcise (the foreskin may be needed for repair), and refer for surgical correction in infancy; consider a DSD work-up in proximal hypospadias with undescended testes.
Symptom sorter
Recognise it.
Diagnostic algorithm
Each step answers one question. Tap to expand.
Treatment ladder
Preserve the foreskin, correct the anomaly surgically (straighten, reposition the meatus, achieve good cosmesis), and individualise distal versus proximal repairs.
Complications
- Abnormal voiding stream, curvature, cosmetic/psychological impact if untreated
- Urethrocutaneous fistula, meatal stenosis, stricture, recurrent chordee
- Preserve foreskin; meticulous, well-vascularised repair; correct chordee fully
- Revision for fistula/stenosis/stricture/chordee
Follow-up
- Voiding (straight forward stream), cosmesis
- Complications: fistula, meatal stenosis, stricture, recurrent chordee
- Postoperative review; longer-term for late complications
- Straight penis, glanular forward-directed meatus, good function and cosmesis
- Urethrocutaneous fistula, meatal stenosis/stricture, recurrent chordee
- For obstructive symptoms (stricture) as needed
- Fistula/stricture needing revision; psychological/cosmetic considerations
Memory hooks
Triad: ventral meatus + chordee + hooded foreskin.
Never circumcise — save the foreskin for repair.
Repair in infancy; distal simple, proximal may be staged.
Proximal + undescended testes → think DSD.
Board traps
Do not circumcise a baby with hypospadias.
Proximal hypospadias + bilateral undescended testes → DSD evaluation.
Fistula/meatal stenosis as classic complications.
Clinical cases
A newborn boy has a urethral meatus on the ventral penile shaft, ventral curvature, and an incomplete (dorsally hooded) foreskin. The parents ask for a routine circumcision.
What is the diagnosis and what key advice applies?