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this shows that the majority of cases have a coronal opening

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this is a more detailed diagram of the types

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this shows normal, hypospadias, and severe hypospadias

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- sub coronal : opening of the urethra is near the head of the penis
- mid shaft : opening of the urethra is on the shaft of the penis
- penoscrotal : opening of the urethra is located where the scrotum and penis meet

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Centers for Disease Control and Prevention

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Hypospadias (pronounced hype-oh-spay-dee-us) is a birth defect in boys where the opening of the urethra (the tube that carries urine from the bladder to the outside of the body) is not located at the tip of the penis.
What is Hypospadias?

Hypospadias is a birth defect in boys in which the opening of the urethra is not located at the tip of the penis. In boys with hypospadias, the urethra forms abnormally during weeks 8-14 of pregnancy. The abnormal opening can form anywhere from just below the end of the penis to the scrotum. There are different degrees of hypospadias; some can be minor and some more severe.

Types of Hypospadias

The type of hypospadias a boy has depends on the location of the opening of the urethra:

Subcoronal: The opening of the urethra is located somewhere near the head of the penis.

Midshaft: The opening of the urethra is located along the shaft of the penis.

Penoscrotal: The opening of the urethra is located where the penis and scrotum meet.

Other Problems

Boys with hypospadias can sometimes have a curved penis. They could have problems with abnormal spraying of urine and might have to sit to urinate. In some boys with hypospadias, the testicle has not fully descended into the scrotum. If hypospadias is not treated it can lead to problems later in life, such as difficulty performing sexual intercourse or difficulty urinating while standing.

Occurrence

It is estimated that each year about 5 boys out of every 1,000 born in the United States have hypospadias, making it one of the most common birth defects.

Causes and Risk Factors

The causes of hypospadias in most infants are unknown. In most cases, hypospadias is thought to be caused by a combination of genes and other factors, such as things the mother comes in contact with in her environment, or what the mother eats or drinks, or certain medications she uses during pregnancy.

Just like the many families affected by birth defects, CDC wants to find out what causes them. Understanding the risk factors that are more common among babies with birth defects will help us learn more about the causes. CDC funds the Centers for Birth Defects Research and Prevention, which collaborate on large studies such as the National Birth Defects Prevention Study (NBDPS; births 1997-2011) and the Birth Defects Study to Evaluate Pregnancy exposureS (BD-STEPS; began with births in 2014), to understand the causes of and risks for birth defects, like hypospadias.

In recent years, CDC researchers have reported important findings about some factors that affect the risk of having a baby boy with hypospadias:

Age and weight: Mothers who were age 35 years or older and who were considered obese had a higher risk of having a baby with hypospadias.

Fertility treatments: Women who used assisted reproductive technology to help with pregnancy had a higher risk of having a baby with hypospadias.

Certain hormones: Women who took certain hormones just before or during pregnancy were shown to have a higher risk of having a baby with hypospadias.

CDC continues to study birth defects like hypospadias and how to prevent them. If you are pregnant or thinking about becoming pregnant, talk with your doctor about ways to increase your chance of having a healthy baby.

Diagnosis

Hypospadias is usually diagnosed during a physical examination after the baby is born.

Treatments

Treatment for hypospadias depends on the type of defect the boy has. Most cases of hypospadias will need surgery to correct the defect.

If surgery is needed, it is usually done when the boy is between the ages of 3-18 months old. In some cases the surgery is done in stages. Some of the repairs done during the surgery might include placing the opening of the urethra in the right place, correcting the curve in the penis, and repairing the skin around the opening of the urethra. Because the doctor might need to use the foreskin to make some of the repairs, a baby boy with hypospadias should not be circumcised.

Other Resources
The views of this organization are its own and do not reflect the official position of CDC.
References

1. Paulozzi LJ, Erickson JD, Jackson RJ. Hypospadias trends in two US surveillance systems. Pediatrics 1997; 100:831-834.

2. Mai CT, Isenberg J, Langlois PH, Alverson CJ, Gilboa SM, Rickard R, Canfield M, Anjohrin SB, Lupo PJ, Jackson DR, Stallings EB, Scheuerle AE, Kirby RS for the National Birth Defects Prevention Network. Brief report, Population-based birth defects data in the United States, 2008 to 2012: Presentation of state-specific data and descriptive brief on variability of prevalence. Birth Def Res (Part A). 2015; 103:972-994.

3. Carmichael SL, Shaw GM, Laurent C, Olney RS, Lammer EJ, and the National Birth Defects Prevention Study. Maternal reproductive and demographic characteristics as risk factors for hypospadias. Paediatr Perinat Epidemiol. 2007; 21: 210-218.

4. Reefhuis J, Honein MA, Schieve LA, Correa A, Hobbs CA, Rasmussen SA, and the National Birth Defects Prevention Study. Assisted reproductive technology and major structural birth defects in the United States. Human Rep. 2009; 24:360-366

5. Carmichael SL, Shaw GM, Laurent C, Croughan MS, Olney RS, Lammer EJ. Maternal progestin intake and risk of hypospadias. Arch Pediatr Adolesc Med. 2005;159: 957-962

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national center on birth defects and developmental disabilities

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Facts about Hypospadias | Birth Defects | NCBDDD | CDC

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CDC works to identify causes of birth defects and opportunities to prevent them. By applying a public health approach incorporating three essential elements-surveillance or disease tracking, research to identify causes, and prevention research and programs-we can rapidly translate scientific findings into appropriate public health interventions.

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- family history
- genetics
- getting pregnant after 35

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- congenital (present at birth)
- exact cause is unknown
- could be genetic
- could be the environment

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- downward curve of penis (chordee)
- spraying during urination
- opening of the urethra anywhere except the end of the penis

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Overview

Hypospadias (hi-poe-SPAY-dee-us) is a birth defect (congenital condition) in which the opening of the urethra is on the underside of the penis instead of at the tip. The urethra is the tube through which urine drains from your bladder and exits your body.

Hypospadias is common and doesn't cause difficulty in caring for your infant. Surgery usually restores the normal appearance of your child's penis. With successful treatment of hypospadias, most males can have normal urination and reproduction.

Symptoms

In hypospadias, the opening of the urethra is located on the underside of the penis instead of at the tip. In most cases, the opening of the urethra is within the head of the penis. Less often, the opening is at the middle or the base of the penis. Rarely, the opening is in or beneath the scrotum.

Signs and symptoms of hypospadias may include:

Opening of the urethra at a location other than the tip of the penis

Downward curve of the penis (chordee)

Hooded appearance of the penis because only the top half of the penis is covered by foreskin

Abnormal spraying during urination

When to see a doctor
Most infants with hypospadias are diagnosed soon after birth while still in the hospital. However, slight displacement of the urethral opening may be subtle and more difficult to identify. Talk to your doctor if you have concerns about the appearance of your child's penis or if there are problems with urination.

Causes

Hypospadias is present at birth (congenital). As the penis develops in a male fetus, certain hormones stimulate the formation of the urethra and foreskin. Hypospadias results when a malfunction occurs in the action of these hormones, causing the urethra to develop abnormally.

In most cases, the exact cause of hypospadias is unknown. Sometimes, hypospadias is genetic, but environment also may play a role.

Risk factors

Although the cause of hypospadias is usually unknown, these factors may be associated with the condition:

Family history. This condition is more common in infants with a family history of hypospadias.

Genetics. Certain gene variations may play a role in disruption of the hormones that stimulate formation of the male genitals.

Maternal age over 35. Some research suggests that there may be an increased risk of hypospadias in infant males born to women older than 35 years.

Exposure to certain substances during pregnancy. There is some speculation about an association between hypospadias and a mother's exposure to certain hormones or certain compounds such as pesticides or industrial chemicals, but further studies are needed to confirm this.

Complications

If hypospadias is not treated, it can result in:

Abnormal appearance of the penis

Problems learning to use a toilet

Abnormal curvature of the penis with erection

Problems with impaired ejaculation

References

1. Baskin LS. Hypospadias. http://www.uptodate.com/home. Accessed Aug. 14, 2016.

2. Kliegman RM, et al. Anomalies of the penis and urethra. In: Nelson Textbook of Pediatrics. 20th ed. Philadelphia, Pa.: Elsevier; 2016. http://www.clinicalkey.com. Accessed Aug. 14, 2016.

3. Epispadias and hypospadias. American Urological Association. https://www.auanet.org/education/modules/pathology/penis-defects/epispadias-hypospadias.cfm. Accessed Aug. 14, 2016.

4. Facts about hypospadias. Centers for Disease Control and Prevention. http://www.cdc.gov/ncbddd/birthdefects/hypospadias.html. Accessed Aug. 14, 2016.

5. Bouty A, et al. The genetic and environmental factors underlying hypospadias. Sexual Development. 2015;9:239.

6. Riggin EA. Allscripts EPSi. Mayo Clinic, Rochester, Minn. July 26, 2016.

7. Granberg CF (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 28, 2016.

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Hypospadias (hi-poe-SPAY-dee-us) is a birth defect (congenital condition) in which the opening of the urethra is on the underside of the penis instead of at the tip. The urethra is the tube through which urine drains from your bladder and exits your body. Hypospadias is common and doesn't cause difficulty in caring for your infant.

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Corrective surgery can be done near 12 months of age

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Urology Care Foundation - What is Hypospadias?

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Most boys are born with a penis that looks normal and works well. But some boys are born with a common condition called hypospadias. Hypospadias forms a penis that not only doesn't work well but also doesn't look normal.

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Usually, having this condition does not mean anything else is wrong with their urinary system

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Condition, only in males, where the meatus (hole) is not at the end of the penis.