Hypospadias is a birth difference in which the urethral opening is on the underside of the penis instead of the tip, anywhere from the glans to the perineum. It often comes with a hooded foreskin and downward curvature, and most cases are repaired in infancy.
Key symptoms
- Urethral opening on the underside of the penis
- Hooded foreskin that is incomplete underneath
- Downward curve of the penis (chordee)
- Urine stream that sprays or points down
What you find on exam
- Locate the meatus and grade it as distal, middle or proximal
- Check penile curvature and the foreskin
- Feel for both testes
- Look for an inguinal hernia
Tests
- Usually no tests for isolated distal hypospadias
- Karyotype and hormone tests if severe or a testis is not felt
- Kidney ultrasound if other anomalies are present
- Pelvic ultrasound if a difference of sex development is suspected
Treatment basics
- No circumcision; the foreskin is used in the repair
- Refer to pediatric urology
- Surgical repair usually between 6 and 18 months
- Follow-up for fistula, stricture or recurrent curvature
Red flags
- Hypospadias with an undescended testis (possible difference of sex development)
- Severe proximal hypospadias
- Weak stream or straining after repair
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.