What is hypospadias/epispadias?

The urethra is the tube that carries the urine from the bladder to an external opening. In boys, that tube goes to the tip of the penis and also carries semen. Hypospadias is a birth defect of the urethra where the tube stops short of the tip of the penis. There are different degrees of hypospadias, depending on how far away the end of the urethra is from the tip of the penis. Hypospadias may cause a curvature of the penis, called chordee. Some cases of hypospadias result in a man who will be unable to urinate while standing up, perform sexual intercourse, and/or procreate. Children with hypospadias should not be circumcised because the foreskin, which is removed during circumcision, is a source of tissue that surgeons use to rebuild the missing part of the urethra.

Epispadias is a problem both boys and girls can have. In girls with epispadias, the urethral opening is in the belly area instead of between the clitoris and labia. In boys with epispadias, the urethra generally opens on the top or side of the penis rather than the tip. However, it is possible for the urethra to be open the entire length of the penis.

Sometimes children with hypospadias have other complications, such as undescended testicles, inguinal hernias, urinary tract anomalies, or vesicoureteral reflux.

What causes it?

No one knows for certain what causes hypospadias or epispadias but several possibilities have been explored. Researchers have found some evidence of genetic causes, such as a larger incidence of the condition in twins and within families. Babies with mothers who were exposed to increased levels of progesterone, a hormone commonly used during in vitro fertilization, have higher rates of hypospadias. Also, exposure to estrogen during pregnancy (exposure can happen when a pregnant mom eats fruits and vegetables with pesticides on them or drinks milk from pregnant cows) may be a risk factor. Hypospadias is more common in babies of Jewish and Italian descent.

How is it treated?

Hypospadias/epispadias is corrected through surgery, which usually is performed at 6-12 months of age. In severe cases, the best option may be for the Children's team to perform the surgery while the child is still in utero.

About surgery for hypospadias/epispadias at Children's

The pediatric urology surgery team at Children's provides next-generation care to neonatal infants, newborns, children, and adolescents from throughout the Upper Midwest. The team consistently performs some of the most cutting-edge surgical procedures available, including newborn surgery, minimally invasive surgery, and robotic surgery, when appropriate. Urologic surgery is performed at Children's - Minneapolis, Children's - St. Paul and Children's - Minnetonka.

  • If you are a family member looking for a Children's specialist in urology surgery, please call the Center for Pediatric Urology at 1-800-992-6983.
  • If you are a health professional looking for a consultation or referral information, please call Children's Physician Access at 1-866-755-2121 (toll-free).