A 2-week-old infant was assessed for an abnormal penis with a dorsal hood and a meatus that extended to the corona. Both testes were palpable in the scrotum. No chordee was apparent.
Hypospadias occurs in 1 in 250 male newborns.1 In neonates with this congenital anomaly, the urethral meatus is ectopically positioned to open proximal to the normal site and on the ventral aspect of the penis or, in severe cases, on the scrotum or perineum. The prepuce is incompletely developed over the glans and presents as a hood. Some cases are associated with a chordee, which causes a ventral curvature of the penis with erection.
Hypospadias is classified according to the location of the urethral meatus, which can be anterior or distal (glandular, coronal, subcoronal), middle (mid penile), or posterior or proximal (posterior penile, penoscrotal, scrotal, perineal). The subcoronal position is the most common. Hypospadias is usually an isolated anomaly. However, 10% of patients have an undescended testis,1 and inguinal hernias are common. Only the more severe cases require a workup for associated genitourinary anomalies.
Complications of untreated hypospadias are deformed urinary stream with accompanying social embarrassment, sexual dysfunction, infertility, and, rarely, meatal stenosis.
Surgical repair is indicated in all cases except the few without functional impairment. Surgery can usually be done on an outpatient basis as a single procedure at age 6 to 12 months. The complication rate is low, and the child may not remember the procedure. Surgery requires technical expertise and should be performed by one with training and experience. This child was referred to a pediatric urologist. Repair of the hypospadias was scheduled for about 1 year of age.
Circumcision should never be performed on a newborn with hypospadias because the foreskin may later be used to form part of the urethra or cover the ventral penile surface. Suspect the possibility of an intersex condition if a child with hypospadias also has cryptorchism and the gonads are not palpable. *