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If your newborn son has been diagnosed with hypospadias, you likely have many questions. This guide explains everything clearly — what it is, what causes it, how it is treated, and what to expect. You are not alone, and with the right care, your child can live a completely normal life.
Male births affected
Surgery success rate
Ideal age for surgery
Hypospadias (pronounced hi-poe-SPAY-dee-us) is a birth condition in which the opening of the urethra — the tube that carries urine out of the body — is not at the tip of the penis as it should be, but somewhere on the underside. This happens while the baby is still developing in the womb, during the formation of the penis and urinary passage.
It is the most common penile problem seen in male children. The good news is that it does not affect your child’s general health and, with surgery, most boys go on to lead completely normal lives.
Hypospadias is a well-understood condition. Experienced surgeons perform this surgery routinely, and success rates are high. Early diagnosis — often before you even leave the hospital — means treatment can be planned at the best possible time.
Hypospadias is classified by where the urethral opening is located. The further the opening is from the tip of the penis, the more complex the treatment:
| Type | Severity |
|---|---|
| Glandular | Mild |
| Subcoronal | Mild |
| Distal Penile | Mild |
| Mid-Penile | Moderate |
| Proximal Penile | Severe |
| Scrotal | Severe |
| Perineal | Severe |
The mild varieties (distal types) are the most common and are usually corrected with a single surgery. Severe varieties may need two-stage surgery, with a six-month gap between the two procedures.
Most cases of hypospadias are diagnosed by doctors immediately after birth during the newborn examination. However, parents should be aware of the following signs:
If you notice any of these signs, or if you are unsure about the appearance of your baby’s penis, speak with your paediatrician or a paediatric surgeon without delay. Early assessment leads to the best outcomes.
Hypospadias is a multifactorial condition, meaning no single cause has been identified. It begins during pregnancy, when the urethra and foreskin are forming. A disruption in hormone signals during this period prevents complete development, leaving the urethral opening in the wrong position.
boys born to fathers or brothers with hypospadias are at higher risk
certain gene changes may alter hormone activity during fetal development
mothers over 35 may have a slightly higher risk of having an affected child
use of fertility treatments or hormone therapies during pregnancy
incomplete development in some preterm babies
possible links to pesticides and industrial chemicals are being studied, though not yet confirmed
Diagnosis is made through physical examination by a doctor. No special test or scan is needed to confirm hypospadias itself. However, once diagnosed, the doctor will arrange routine pre-operative blood tests, including a complete blood count and screening for Hepatitis B and C, before any surgery is planned.
An important part of the assessment is also evaluating whether chordee (bending of the penis) is present, as this directly affects how surgery is planned.
Surgery is the only effective treatment for hypospadias. The goal of surgery is to give your child a normally functioning penis — with the urine opening at the tip, a straight shaft, and a natural appearance.
The ideal age for hypospadias surgery is between 6 and 18 months. Operating during this window is safe, the tissue heals well, and the child will not remember the experience. If your child is older at the time of diagnosis, surgery can still be performed at any age.
For mild and distal types, a single surgery is usually sufficient. For more complex or severe varieties, a two-stage repair is planned, with the two operations separated by approximately six months. The surgeon will advise the most appropriate approach after examining your child.
The surgery itself takes approximately two to three hours. After the procedure, a small catheter (tube) is left in place to allow healing and is removed after seven to fourteen days.
While mild cases near the tip may not always require surgery, most types should be treated. Without treatment, hypospadias can lead to:
Pain after this surgery is generally manageable and not a major concern. Simple oral pain relief medicines are usually enough to keep your child comfortable during recovery at home.
The overall success rate is more than 95% across all types of hypospadias. Mild varieties have very high success rates with a single surgery. In complex cases, more than one surgery may be needed, but outcomes are generally excellent in experienced hands.
In the vast majority of cases, hypospadias does not cause infertility. Many men with untreated mild hypospadias father children without difficulty. However, in severe varieties — particularly when combined with undescended testes or a significantly bent penis — fertility can be affected. This makes timely treatment all the more important.
In mild types, size is not significantly different from other children. In severe varieties, the penis may be smaller than average, both before and after puberty. Your surgeon can discuss this with you in detail during the consultation.
MIP is a rare, mild form of hypospadias that is usually only discovered during circumcision, because the foreskin appears completely normal at birth. Once the foreskin is removed, the urethral opening is found to be wider than normal or in a slightly different position. It is treated in the same way as other distal types.
There is a higher-than-average chance of recurrence in families where hypospadias has already occurred. If you have concerns about future pregnancies, speak with your doctor or a genetic counsellor for personalised guidance.
The time it takes to complete the surgery for hypospadias varies depending on how severe it is. Mild cases of hypospadias can take 1-3 hours, but more severe forms may require three or more hours.
Hypospadias surgery at KidsCare Hospital Rawalpindi is performed by two highly experienced paediatric surgeons. Dr. Muhammad Umar Nisar is a (Neonatal, Paediatric & Laparoscopic Surgeon) with over 15 years of experience, specialising in complex urological repairs including multi-stage hypospadias surgery. Dr. Muhammad Umar Qureshi is also a Neonatal, Paediatric & Laparoscopic Surgeon with 10+ years of experience, skilled in both routine and advanced paediatric surgical procedures. Together, they bring decades of combined expertise to ensure the safest and most effective outcomes for your child.
KidsCare Hospital Rawalpindi is a trusted centre for paediatric surgery in the twin cities of Rawalpindi and Islamabad. Our dedicated paediatric surgical team has successfully treated children with all types and severities of hypospadias — including complex cases requiring multi-stage repair. We offer a child-friendly environment, experienced neonatal and paediatric surgeons.. Parents from across Rawalpindi, Islamabad, and surrounding areas choose KidsCare Hospital for the quality of care and the reassurance of being in specialist hands from the very first consultation.
