Discovering that a newborn boy has hypospadias can be an overwhelming and emotional experience for many parents. Often, they are filled with worry, confusion, and guilt, wondering if they might have done something wrong during pregnancy.
The condition is rarely discussed openly, and this silence can leave families feeling isolated, unsure of what it means for their child’s future or where to turn for help.
Misunderstanding and stigma from society can further intensify the emotional burden, sometimes leading families to delay seeking medical care. Yet with the right information and support, hypospadias does not have to define a child’s life or limit a family’s hopes.
Hypospadias is a congenital condition that affects boys and results in abnormal development of the penis.
Specifically, the urethra, the tube that carries urine from the bladder to the outside of the body, opens somewhere along the underside of the penis instead of at the tip. In severe cases, the opening may be located as far down as the scrotum.
Globally, hypospadias affects about one in every 200 to 300 boys. In Sub-Saharan Africa, it appears to be less common, occurring in roughly 1.5 out of every 1,000 boys. Though local data is limited, similar patterns are seen in East Africa, including Kenya, highlighting the importance of raising awareness and understanding within the region.
The exact causes of hypospadias remain unclear, and in most cases, no specific reason can be identified.
Genetic, hormonal, and environmental factors may contribute, but parents should know it is usually not their fault. While most families have no history of the condition, there is a slightly increased risk if a sibling or parent has had hypospadias.
Some studies have linked its occurrence to prenatal exposure to pesticides, synthetic hormones in food, certain fertility treatments, and premature births. However, a direct causal relationship has yet to be firmly established.
In rare cases, hypospadias may be associated with other conditions like undescended testes, kidney anomalies, or intersex traits, often pointing to underlying genetic or hormonal causes.
Treatment for hypospadias is essential for both functional and psychological reasons. Boys with the condition may struggle to urinate while standing, and severe forms can lead to chronic urinary tract infections or cause urine to spray unpredictably.
Many also have an associated bending of the penis, known as chordee, which can cause painful erections or lead to sexual dysfunction later in life.
The foreskin is usually underdeveloped on the front side, giving the penis an unusual appearance. These physical differences can result in social challenges, particularly as the child grows older and becomes more aware of their body.
Early detection and intervention are crucial to help boys develop confidence and avoid the stigma or discomfort associated with untreated hypospadias.
Diagnosis typically occurs at birth during the newborn examination. Paediatricians or nurses usually notice the misplaced urethral opening or curvature of the penis. If missed, the condition may be identified later during circumcision, especially due to the unusual shape of the foreskin. In most cases, additional testing is unnecessary unless there are concerns such as undescended testicles.
Surgical correction is the primary treatment for hypospadias and is ideally performed between 4 to 18 months of age. The surgery aims to straighten the penis, reconstruct the urinary channel, move the urethral opening to the tip, and provide a more typical cosmetic appearance.
Depending on severity, this may be done in a single procedure or over multiple stages.
Even though outcomes are generally excellent, complications such as fistulas or urethral strictures can occur in 5–30 percent of cases, depending on the complexity and the surgeon's experience. These are usually treatable, with additional surgery performed 6–12 months later if needed. With proper care and follow-up, most boys regain normal function and appearance.
While there is no guaranteed way to prevent hypospadias, maintaining a healthy pregnancy and minimising exposure to potential environmental risks may help reduce chances.
Ongoing research continues to explore the genetic and environmental factors behind this condition, offering hope for improved prevention and treatment strategies in the future.
The writer is a Senior Instructor, Aga Khan University Medical College and Consultant Paediatric Surgeon at Aga Khan University Hospital, Nairobi
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