Little baby boys pass urine like a fountain. Small lads can stand and pass urine straight with an ability to point the stream where they want, like a fire-man’s hose. This is possible because the urine comes out of the opening at the tip of the penis. 

In boys with hypospadias, the opening is located on the under surface of penis. Because of this the urine is deviated downwards towards their feet. The picture shows normal arrangement and hypospadias

Hypospadias occurs in one in 300 male newborns. When the paediatrician checks out the baby, or when the parents bath the baby, the following features can make one suspect hypospadias

Urine opening on the under surface of the penis 
Penis being slightly bent downwards 
Excess foreskin on the top of the penis 

What are the consequences of Hypospadias?

When hypospadias is left uncorrected, the following consequences can develop

Unlike the normal lads who can stand and pass urine, hypospadiac lads have to sit; if they stand and pass urine, it goes down the leg. 

When they get older, because of the bent in penis, sexual activities become difficult. Also they have much lower chance to have children, as they can’t deposit the sperm normally. The sperm leaks out through the opening located underneath. 
Sometimes the urinary opening is also small, leading to blockage in urine stream. This leaves them at a risk of urinary infection. 
Do they have other birth defects? Can the same problem recur in future children?

In general, hypospadiac children do not have other kidney abnormalities. However in 10% of these kids, the testis may not be descended normally. When both testes have not come down normally, they can have associated hormone defects. When the first child or the father has hypospadias, there is a slightly higher chance (7-10%) for the future boys in the family to have the same birth defect.

What is the right time to correct hypospadias?

From 6 months onwards, hypospadias can be corrected by an operation. By completing the operation before 2-3 years of age, these children can be toilet trained normally like any other child. Not having an appearance like other boys at school, can lead to emotional problems in these children. 

What does the operation involve? What are the complications?

Most of the hypospadias belong to the mild variety and can be operated by a single stage operation. When the opening is too far down from the tip, they might require two-stage operation. The operation is usually done under general anesthesia and a catheter/ dressing is left for 5-7 days. Three things are corrected during the operation. 

The opening is brought to the tip 
The penis is straightened 
Excess foreskin is removed (circumcision. 
Optical magnification (microscope) and fine suture materials are essential for a successful result. When extra care is taken there is a very good (95%) success rate. In 5% the following complications can occur. 

The new opening gets small gradually (meatal stenosis) 
Urine leaks at the original site (Fistula) 
Both these can be corrected by another minor operation; so the parents need not have undue concern about this.

What are the chances of fertility after operation?

Straight penis and an opening at the tip are essential for a successful married life and fertility. When the problem is corrected by 1-3 years of age with a good outcome, there should be no problem in future for fertility.

Key Points: 

In children with hypospadias, the opening is on the under surface of penis. 
Because of this, these lads can’t stand and pass urine like normal children. 
They can have infertility in later life, if left uncorrected. 
By performing a corrective surgery at the right age, these can be avoided.