Hypospadias

Introduction

Hypospadias is a condition boys are born with where the penis does not fully form on the underside during early pregnancy. It affects about 1 in 150 to 300 boys. The tube that carries pee from the bladder (urethra) stays short and opens somewhere along the underside of the penis instead of at the tip. This can make the penis curve downward (chordee) and leave the foreskin incomplete on top.

It ranges from mild to more involved—the farther back the opening, the stronger the curve, or other issues, the trickier it can be. Doctors get the full picture during surgery when they see the tissues up close.

Causes and Risk Factors

It is important to understand that there is nothing an expecting mother could have done during pregnancy to result in hypospadias. The exact reason is usually unknown, but it is likely a mix of nature (genetics) and nurture (environment) working together. Risk factors include babies born early (premature), those smaller than expected for their age, slowed growth in the womb, or a family history of hypospadias. No one is to blame—it is just how the baby developed early on.

Signs and Symptoms

Boys with hypospadias often have no pain when peeing, but the stream might spray downward. In worse cases, they may need to sit to pee, or have a very narrow stream from a tiny opening. It is usually spotted right after birth by the penis's look, though mild cases might hide until later.

Diagnosis

The three key signs are: 1) pee hole on the underside (not tip); 2) downward curve (not always); 3) hooded foreskin covering only the top of the head (not always). Mild forms have the opening just below the tip; severe ones near the middle, base, or even scrotum.

Treatment and Management

If your baby is found to have hypospadias at birth, skip circumcision—the foreskin is often needed for surgery later—and see a paediatric urologist right away.

During the first urologist visit, the doctor will check the penis closely to confirm hypospadias, measure how serious it is, and look for related issues like undescended testes, a very small penis, or scrotum problems (signs the genitals did not fully develop).

If it is severe or has other features, we will refer your child to our HKCH multidisciplinary team clinic where hormone experts (endocrinologists) and clinical geneticists will check if more tests are needed. Surgeons will then explain if surgery is required, when to do it, and how—tailored to your child's case.

Most boys need surgery to straighten the penis and move the pee opening to the tip for better urination and future sexual function. It might take one or two steps, usually at around 12-18 months old (before potty training or school), under general anaesthesia. Many go home the same day, with a temporary catheter in the diaper for a few days to 2 weeks for healing, plus antibiotics, pain medicine, and simple wound cleaning tips from your doctor.

All surgeries have some risks, but our team works hard to keep them low. Here are the main ones for hypospadias repair:

• Bleeding: Blood in urine or from the wound—usually minor and stops on its own
• Infection: Treated quickly with antibiotics
• Meatal stenosis: The new pee opening gets too narrow
• Urethral stricture: Narrowing inside the new urethra
• Breakdown of repair: The fix does not hold fully
• Residual chordee: Some penis curve remains
• Urethral fistula: Urine leaks from an abnormal spot

Some kids may need a small follow-up surgery to fix these. This is general info—not everything possible—and risks vary by child. Talk to your doctor for details on your baby's case.

Follow-up Care

After hypospadias surgery, we will book follow-up visits at our paediatric urology clinic to check for any issues and track long-term progress.

The outlook for hypospadias is generally very good, especially for milder cases treated properly—most boys grow up with a penis that works normally for peeing and later life. Regular check-ups ensure any rare problems get fixed early.

References

• Centers for Disease Control and Prevention. (n.d.). Hypospadias.
• Hoag CC, Gotto GT, Morrison KB, Coleman GU, Macneily AE. Long-term functional outcome and satisfaction of patients with hypospadias repaired in childhood. Can Urol Assoc J. 2008;2(1):23-31. doi:10.5489/cuaj.521

Acknowledgement

Principal author: Dr Wong Yuen-shan Sammi on behalf of Department of Paediatric Surgery, HKCH

Initial posting: Oct 2026

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