Hypospadias In Newborn: Causes, Symptoms, And Treatment

Hypospadias in newborns is diagnosed during the routine physical examination conducted after birth. It is a congenital disability where the urethra opens in abnormal locations instead of at the tip of the penis. Hypospadias is a common condition found in about one per 250–300 births (1).

While the exact cause of hypospadias is sometimes unknown, it is a treatable condition and may lead to long-term problems, including difficulty during urination, if left untreated. This post discusses the symptoms, causes, and treatment options for hypospadias in babies.

What Is Hypospadias?

Hypospadias is a birth defect in which the urethra (the tube that carries urine from the bladder to the outside of the body) does not open at the tip of the penis. In hypospadias, the urethral opening(meatus) could be at abnormal locations, such as the shaft of the penis or near the scrotum.

Hypospadias occurs when there is abnormal development or formation of the urethra during eight to 14 weeks of pregnancy (2). This condition could occur in varying degrees ranging from minor to severe.

Types Of Hypospadias In A Newborn

Hypospadias is classified based on the location of the urethral opening (2) (3).

1. Distal/glandular/subcoronal: It is the most common type of hypospadias in which the urethral opening is closer to the head of the penis.

2. Midshaft: The opening is located at the middle of the penis or anywhere along the shaft of the penis.

3. Penoscrotal: The urethral opening is located at the point where the penis and scrotum meet.

4. Perineal: It is the most severe and least common type in which the opening is located behind the scrotal sac.

What Causes Hypospadias?

There is no definite cause of hypospadias in babies(1). Experts believe that a combination of genetic and environmental factors could lead to the abnormal development of the urethra during gestation. Certain risk factors may be associated with the development of hypospadias in boys.

Risk Factors For Hypospadias

The following factors may increase the risk of hypospadias in babies (4) (5).

1. Genetics: Research indicates that about 7% of babies with hypospadias have a paternal history, which means their fathers also had hypospadias. Almost 21% of babies with hypospadias have a father and brother affected by the condition. The development of the penis in the fetus is affected by genes. Therefore, abnormal genes associated with hypospadias may play a role in increasing a boy’s risk of developing the condition.

2. Maternal age: Women over the age of 35 have an increased risk of delivering a baby with birth defects, including hypospadias. The decline in the quality of an ovum with age may be the underlying cause.

3. Maternal weight: Obese mothers may have an increased risk of having a baby boy with hypospadias. It is not known how maternal body weight affects the risk of hypospadias. The conditions usually associated with obesity, such as high blood pressure and diabetes, might be the underlying factors.

4. Maternal lifestyle: Unhealthy maternal habits and diet during pregnancy could increase the risk of birth defects in general. Women who smoke tobacco, consume alcohol, and indulge in narcotics may have a higher risk of giving birth to a baby with hypospadias. A poor diet deficient in vital nutrients, such as folic acid, may also increase the risk.

5. Fetal hormones: The development of the penis in the fetus happens during eight and 14 weeks of pregnancy. Abnormal action of fetal hormones for some underlying reason may affect the formation of the penis and urethra, increasing the risk of hypospadias.

6. Maternal hormones: Maternal hormonal problems may also cause the problem. A mother’s hormones could be affected due to exposure to compounds, such as chemicals and harmful toxins. Mothers who undergo fertility treatment for conception may receive medications and a high dose of hormones, such as progesterone, that may increase the risk of birth defects, including hypospadias.

Symptoms Of Hypospadias In A Newborn

The doctor will check for signs of birth defects after birth. Most cases of hypospadias are diagnosed during physical examination immediately after birth or during routine check later.

Below are the signs and symptoms of hypospadias in babies (6).

• Urethral opening not located at its usual place (head of the penis)

• Abnormal spraying or lack of constant stream during urination

• Glans (head) of the penis is abnormally shaped

• Abnormal curvature of the penis (chordee)

• Babies with hypospadias often also display abnormalities of the foreskin, such as shorter foreskin

In rare cases, if hypospadias has gone undiagnosed during infancy, older babies and toddlers could display an inability to urinate correctly while standing.

Treatment For Hypospadias

The doctor will assess the type of hypospadias, the presence of urinary problems, and possible prognosis to decide the treatment. Mild distal hypospadias may not require any treatment if there are no abnormalities of the urinary system and if the condition is unlikely to interfere with other functions later in life.

Moderate distal hypospadias to perineal hypospadias usually requires treatment since leaving them untreated could cause complications later in life, such as problems during sexual activity and inability to urinate while standing. The condition cannot be cured with medication, and surgery is the only option. The surgery is usually performed between the ages of six and 12 months, although in some cases, the doctor may wait up to 24 months(1).

Below are some of the salient points about surgery for hypospadias (7) (8).

• The doctor may prescribe medicines a day in advance or administer injections right before surgery to prepare for the surgery.

• The surgery is performed under general anesthesia and may last up to four hours.

• The surgery aims to reposition the urethral opening to the tip of the penis and correct any other problems, such as rectifying the abnormal curvature of the penis.

• If the hypospadias is severe or if there are other concurrent problems, the baby may require multiple surgeries, which may be conducted at different ages.

• Most babies can return home the same day. A catheter is placed in the urethral opening to drain the urine outwards, and the baby can wear a diaper over it. The catheter may be removed in a week to two weeks.

You may have to observe the following post-operative care procedures to avoid complications (9).

• You will need to administer the prescribed antibiotics to avoid infections.

• Parents and caregivers will be taught ways to take appropriate care of the catheter.

• The doctor will tell you about the positions to avoid while laying the baby to play or bathe. You may have to avoid straddling the baby in carriers or other similar equipment that puts pressure on the crotch.

• You may be asked to avoid circumcising the baby as the foreskin may be required for correction during surgery.

It is normal for the baby’s urine to be pinkish for a few days after surgery. Consult a doctor soon if your baby develops a fever, the site of operation appears excessively swollen, there is bleeding from the penis, or the baby is unable to urinate.

The effects of the surgery last forever, and the baby will have normal development of the genitals as they grow older.

Prevention Of Hypospadias

There is no precise way of preventing hypospadias. The condition is difficult to diagnose during prenatal ultrasonography.

You may avoid the risk factors by observing the following precautions(1).

• Observe healthy habits during pregnancy, such as avoiding substance abuse and eating a balanced diet. Speak to your doctor to learn about the supplements you must consume.

• Maintain a healthy weight before conceiving to reduce the risk of maternal obesity- or diabetes-related complications in the fetus.

• Avoid exposure to compounds and medications that are known to increase the risk of congenital defects.

• If you intend to conceive through fertility treatment, discuss with your doctor the type of hormones you will need and their effect on the fetus.

• Take your baby to regular checkups after birth. Mild hypospadias may go unnoticed initially and may only be discernible as the baby grows.

References

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Reviewer

Dr. Neema ShresthaMD

     

Dr. Neema Shrestha is a pediatrician with a special interest in the field of neonatology. She has an overall experience of five years working in the field. Currently working in Kathmandu, Nepal, she completed her MBBS from Kasturba Medical College, Manipal in 2008, Diploma in Child Health from D.

Read full bio of Dr. Neema Shrestha