Sometimes it is possible to diagnose hypospadias during pregnancy, but usually the diagnosis is only confirmed after birth.

There is definitely NO indication for abortion because of hypospadias.

The exact cause of hypospadias is not known, but certainly it is not the parents’ fault. Usually, hypospadias is sporadic. When one child has hypospadias, it does not increase the chances of hypospadias for other children in the family.

However, some families have a genetic predisposition — for example, if the father, uncle, or grandfather had hypospadias. In those families, more than one child can be affected.

There are some geographical and racial variations. Several publications report the incidence of hypospadias to be one in every 125 newborn boys. In the United States, a study reported that hypospadias was the most common congenital anomaly among whites. The incidence has been rising during the 1970s and 1980s.

Usually, parents seek surgical advice and have the son’s hypospadias corrected and never talk about it again. That is why hypospadias is not a public topic that people talk about.

During the first 3 months of life. This is because the optimal window for hypospadias correction is between 3 and 18 months. It is ideal to seek the advice of an experienced specialist.

The specialty of the surgeon is not important. What is important is that the surgeon must have special interest in hypospadias and performs adequate number of hypospadias operations per year to develop experience and to have good results.

An appropriate question the parents may ask before they decide on a particular surgeon is to ask the surgeon how many hypospadias repairs he performs per year and what are his results and complication rate.

There is general agreement, supported by several scientific studies, that hypospadias repair should be limited to centers performing 50 hypospadias repairs or more per year. The complication rate following distal hypospadias should be less than 10% (ideally less than 5%). The complication rate following proximal hypospadias should be less than 25% (ideally less than 15%).

There are several factors that determine the severity of hypospadias. However, as a general rule: if the opening is in the glans, this is glanular hypospadias or Grade I. If the opening is in the outer half of the penis, this is considered a moderate degree or Grade II. If the opening is in the inner half of the penis, this is proximal hypospadias or Grade III. If the opening is in the scrotum and the scrotum is usually bifid, this is perineal hypospadias or Grade IV. Please see examples below.

In reality, the actual position of the meatus and the kind of the technique that is suitable for the child and the degree of curvature can only be accurately decided in the operating theatre when the child is asleep.

Mild or moderate degrees (grade I, II) of hypospadias constitute about 85%. Proximal hypospadias constitutes about 10%. Perineal hypospadias is about 5% of the total incidence.

Grade I: Glanular Hypospadias

Glanular hypospadias is a mild form (10%). The urethral opening is in the glans. A bridge or skin fold just outside the urethral opening may suggest that the urethra is long enough to reach the glans tip.

Mega-meatus Intact Prepuce (MIP) Hypospadias

This rare form (2%) presents with a complete foreskin, making early diagnosis difficult. Diagnosis often occurs during foreskin retraction for cleaning or circumcision. A rotated median raphe may indicate MIP.

Grade II: Distal Hypospadias

The most common form (75%). The opening is within the outer half of the penis and may involve mild curvature (chordee), usually corrected with skin mobilization.

Grade IIIa: Proximal Hypospadias without deep chordee

Represents about 10%. Half of these do not have deep chordee. Surgical exploration confirms chordee severity.

Grade IIIb: Proximal Hypospadias with deep chordee

Represents about 5%. Surgery begins by straightening the penis before urethral reconstruction.

Grade IV: Perineal Hypospadias

A severe form (<5%) possibly associated with undescended testis and considered a form of Disorders of Sexual Development (DSD). Hormonal therapy may help in cases with small phallus.

a) Glanular Hypospadias (Grade I)

If the child has a glanular hypospadias (Grade I), the operation may not be necessary from a functional point of view. This means that he may not have problems with urination, erections, or sexual function later in life.

However, even this mild form may cause psychological issues as the penis may not look normal and could result in wetting clothes during urination. Many adults with uncorrected glanular hypospadias avoid intimate relationships due to concerns over the appearance of their penis.

Professor Hadidi recommends surgical correction, as the chance of achieving an almost normal appearance is over 99%, with a complication rate of only 1%. Many adult patients visit the hypospadias clinic later in life seeking correction because of the psychological effects.

b) Distal, Proximal or Perineal Hypospadias (Grades II, III, IV)

If the child has distal (Grade II), proximal (Grade III), or perineal (Grade IV) hypospadias, surgical intervention is necessary to ensure proper urination, erections, and sexual function later in life.

In addition to surgical repair, children with hypospadias may also have a very narrow urethral opening that needs to be widened (dilated) to prevent urinary backflow and avoid infections in the bladder and kidneys.

Yes, in children with glanular (Grade I), distal (Grade II), and the majority of proximal (Grade III) hypospadias, if the operation is done by an experienced surgeon. However, in a small percentage of patients (especially in proximal or perineal forms), complications may occur that may impair the appearance or the function of the penis.

Yes, in all children with glanular, distal, and proximal hypospadias. Perineal hypospadias may have problems due to the size, curvature, or surgical complications.

No. In principle, all the nerves responsible for erection and ejaculation run on the upper surface of the penis. All hypospadias operations for urethral reconstruction are performed on the ventral surface of the penis. So, there should be zero chance to damage those nerves.

The only remote possibility is if the surgeon performs dorsal placation (Nesbit procedure or one of its modifications) to correct chordee or penile curvature, there may be a potential risk to damage these nerves.

There is no surgery without a scar, as surgery is done through an incision in the glans and the penis.

Surgeons try to limit incisions to the midline of the lower surface of the penis, as these incisions heal with the best cosmetic results and in many cases may look like the normal “median raphe” that is normally present in the lower midline surface of the penis.

Luckily, most children (85%) with glanular (Grade I), distal (Grade II), and the majority of proximal (Grade III) hypospadias heal with minimal scarring, especially if the operation is done by an experienced surgeon — but there is no guarantee. Occasionally, some children may heal with obvious unsightly scars that may require further surgery.

The other important fact is that the aim of hypospadias surgery is to correct the chordee (penile curvature), bring the urethral opening to the tip of the penis, and try to make the penis look as close to normal as possible. The penis may “look” a bit longer after surgery if the surgeon corrects the curvature carefully by removing the tethering bands and not by dorsal plication (Nesbit procedure and its modifications), which shortens the upper surface of the penis.

A short penis before surgery will remain short after surgery (especially in Grade IIIb and IV).

This is one of the most commonly asked questions.

According to several scientific studies, the size of the hypospadias penis is comparable to normal penis sizes in normal boys. Also, those studies showed that the sexual function in corrected hypospadias patients is similar to the normal population (apart from severe forms of proximal and perineal hypospadias, Grade IIIb and Grade IV, which constitute less than 10% of children with hypospadias).

Professor Hadidi operates personally on all hypospadias patients with severe grades of hypospadias and patients who come from abroad. Patients with private insurance are operated on in Emma Hospital. Patients with public insurance are operated on in Offenbach Hospital.

Professor Hadidi consults and examines all patients personally before surgery and follows up all his patients personally.

Please send an e-mail to Professor Hadidi with all details like your child’s name and birth date, your address, and telephone number. There are two possibilities:

• To have the operation done in Emma Klinik in Germany.
• To have the operation done in your country. Professor Hadidi travels a few times every year to several countries when there are enough patients to justify the travel.

Recent studies showed that the ideal time for hypospadias correction is between 3 and 18 months, as the penis grows less than 1 cm during the first 3–4 years. Please contact the surgeon as soon as you get the diagnosis to avoid a long waiting time.