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Health condition · Clinically reviewed

Hypospadias, explained for parents - what it is, and what happens next.

One of the most common congenital differences in boys. With specialist paediatric urology care, outcomes are excellent.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against BAUS, BAPU and peer-reviewed paediatric urology sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK paediatric urology practice including tubularised incised plate repair and staged techniques.

Key facts

Hypospadias at a glance.

The essentials, in plain English - what it is, how common, and what the paediatric urology team will offer.

  • What it is

    A congenital penile difference where the urethral opening sits on the ventral side of the penis rather than at the tip.

  • How common

    Around 1 in 200 to 300 male births in the UK, making it one of the most frequent congenital genital differences.

  • Types

    Distal (around 85%), midshaft (10%) and proximal (5%) - severity is defined by meatal position and any chordee.

  • Chordee

    Ventral curvature of the penis, more common in proximal cases and often addressed during the same repair.

  • Timing of repair

    Surgery is usually offered between 6 and 18 months of age at a specialist paediatric urology centre.

  • Do not circumcise

    The foreskin is often used in reconstruction - newborn circumcision should be avoided until a specialist has reviewed.

Why this guide matters

Common, treatable and well understood.

Hypospadias is one of the most researched congenital conditions in paediatric urology. The three points below shape everything else on this page.

  • It is a spectrum

    From a very minor glanular variant to proximal forms with chordee - the plan matches the anatomy of your child.

  • Preserve the foreskin

    Newborn circumcision should be avoided until a specialist has reviewed - the foreskin is often part of the repair.

  • Specialist centres, long follow-up

    UK paediatric urology centres deliver excellent short-term results, and adolescent follow-up protects long-term outcomes.

How the diagnosis is made

From newborn check to a clear plan.

The steps a UK paediatric urology team will normally follow, in order - so parents know what to expect and why.

  1. 01

    Assessing

    Newborn examination

    Picked up at the routine newborn check - a dorsal hood of foreskin and a meatus that is not at the tip are the classic signs.

  2. 02

    Assessing

    Grade the severity

    The paediatric team records meatal position, glans shape and any ventral curvature - distal, midshaft or proximal.

  3. 03

    Assessing

    Family history and pregnancy

    Ask about first-degree relatives with hypospadias, IVF or assisted reproduction, and any endocrine exposures in pregnancy.

  4. 04

    Confirming

    Specialist paediatric urology

    All cases are referred to a specialist commissioned paediatric urology centre - typically within a few weeks of birth.

  5. 05

    Confirming

    Assess for chordee

    Ventral curvature is often only fully seen on artificial erection at the time of surgery - severity guides the operation.

  6. 06

    Preparing

    DSD workup if severe

    Proximal hypospadias with an undescended testicle or ambiguous genitalia needs karyotype, hormone testing and MDT input.

  7. 07

    Preparing

    Plan and consent

    Parents meet the surgeon, review the technique, timing and expected outcomes, and consent to the plan.

Typical timeline: newborn diagnosis, specialist review within weeks, surgery between 6 and 18 months.

Symptoms

What hypospadias looks like.

A recognisable pattern - a ventral meatus, a dorsal foreskin hood and sometimes a downward curve. And the features that mean a wider workup is needed.

  • Ectopic meatus

    The urethral opening sits on the underside of the penis rather than at the tip - the defining feature.

  • Dorsal hood of foreskin

    The foreskin is incomplete on the underside, giving a hood-like appearance on the top of the glans.

  • Ventral chordee

    A downward curve of the penis, more marked on erection and more common in proximal cases.

  • Flat or grooved glans

    The glans is often splayed with a ventral groove leading to the true meatus.

  • Abnormal urinary stream

    Some children have a spraying or downward stream, especially with more proximal meatal positions.

  • Penoscrotal transposition

    In proximal cases the scrotum can sit slightly higher than the penile base - addressed at surgery.

  • Associated undescended testicle

    Occurs in a minority - a combination that prompts further genetic and endocrine assessment.

  • Red flag - ambiguous genitalia

    Proximal hypospadias with impalpable testes needs urgent specialist review to exclude a disorder of sex development.

Treatment

How hypospadias is repaired in the UK.

A tailored operation - most often TIP for distal cases and staged techniques for proximal disease. See our hypospadias repair guide for the surgical detail.

  • Observation for very minor cases

    A glanular meatus with a good stream and no chordee can occasionally be left alone - decided with the specialist.

  • Tubularised incised plate (TIP)

    The most common repair for distal hypospadias - the urethral plate is incised and tubularised in one stage.

  • MAGPI repair

    Meatal advancement and glanuloplasty for very distal cases where the meatus is close to the tip and the glans is favourable.

  • Mathieu flip-flap repair

    A flap of skin just behind the meatus is used to extend the urethra - an alternative distal technique.

  • Onlay island flap

    A flap of inner preputial skin is laid onto the urethral plate for midshaft cases with a preserved plate.

  • Bracka staged repair

    A two-stage buccal or preputial graft repair used for severe proximal hypospadias or after previous failed surgery.

  • Chordee correction

    Ventral curvature is released at the same operation - by degloving, plate transection or dorsal plication as needed.

  • Redo hypospadias surgery

    For fistula, stricture or dehiscence - specialist tertiary centres offer revision using local flaps or buccal grafts.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your paediatric urology team knows your child and can tell you which parts apply. If in doubt, contact them.

  • British Association of Urological Surgeons (BAUS). Patient information on hypospadias.

  • British Association of Paediatric Urologists (BAPU). Standards for hypospadias surgery.

  • European Association of Urology (EAU). Guidelines on paediatric urology - hypospadias.

  • NHS England. Specialised paediatric urology service specification.

Red flags

When hypospadias needs urgent attention.

Most cases follow a well-worn path from diagnosis to repair. These are the situations that need a faster or wider assessment.

  • Ambiguous genitalia at birth

    Proximal hypospadias with bifid scrotum or non-palpable testes needs urgent joint assessment by paediatric urology and endocrinology.

  • Non-palpable testes

    One or both testes not felt in the scrotum alongside hypospadias raises the possibility of a disorder of sex development.

  • Do not circumcise before review

    Newborn circumcision removes tissue often needed for reconstruction - the foreskin should be preserved until surgery.

  • Urinary retention or poor stream

    A very small meatus that causes straining or urinary infection needs earlier specialist review.

  • Post-operative bleeding or infection

    Persistent bleeding, fever or a swollen, red wound after repair should be reviewed by the operating team promptly.

  • Urethrocutaneous fistula

    A new pinhole leak of urine on the shaft after healing is the most common complication and needs revision surgery.

  • Meatal stenosis

    A narrowed new meatus with a fine or spraying stream may need dilatation or a small revision procedure.

  • Recurrent chordee at puberty

    Curvature that reappears as the penis grows - reviewed by adolescent urology and often correctable.

  • Psychological or sexual concerns

    Adolescents and adults may have concerns about appearance, function or fertility - specialist follow-up centres can help.

Living with it

From newborn diagnosis to adult life.

Four things that make the biggest difference along the way - avoid early circumcision, plan surgery well, follow the aftercare plan, and keep long-term appointments.

A quiet reminder

Long-term follow-up matters.

Complications and cosmetic concerns can appear years later. Adolescent and adult review at a specialist centre catches them early.

  1. 01 Newborn

    Skip the circumcision

    Tell your GP and midwife about the diagnosis - the foreskin is often part of the repair and must not be removed.

  2. 02 Timing

    Plan surgery between 6 and 18 months

    Most UK centres operate in this window - young enough to reduce memory of surgery, old enough for safe anaesthesia.

  3. 03 Recovery

    Expect a short catheter and dressing

    Most children go home the same day or the next with a small stent - the surgical team will explain the aftercare.

  4. 04 Follow-up

    Keep the long-term appointments

    Complications can appear years later - adolescent review protects future urinary, sexual and cosmetic outcomes.

Frequently asked

Everything parents ask about hypospadias.

Quick answers on causes, timing of surgery, risks and long-term outcomes.

  • What is hypospadias?

    Hypospadias is a common congenital difference in which the opening of the urethra sits somewhere on the underside of the penis rather than at the tip. It ranges from a very minor glanular variant to a proximal form on the scrotum or perineum, and is often accompanied by an incomplete foreskin and a downward curve of the penis.

  • What causes hypospadias?

    It is thought to result from an interruption in the hormonal signalling that closes the urethral groove during early pregnancy. Genetic factors, reduced androgen action, some endocrine-disrupting exposures, assisted reproduction and maternal factors have all been linked, but in most children no single cause is identified.

  • Does my baby need surgery?

    Most children with hypospadias are offered surgery, usually between 6 and 18 months of age, at a specialist paediatric urology centre. The aim is a straight penis with a meatus at the tip and a normal urinary stream. Very minor distal variants with a good stream and no curvature can occasionally be left alone.

  • Why should we not circumcise a newborn with hypospadias?

    The foreskin is often used to reconstruct the urethra or to cover the repaired penis. A newborn circumcision removes tissue the surgeon may need. Any circumcision decision should wait until a paediatric urologist has reviewed the baby.

  • What are the risks of hypospadias repair?

    The most common complication is a urethrocutaneous fistula - a small hole that leaks urine along the shaft. Other risks include meatal stenosis, wound breakdown, recurrent chordee, urethral stricture and diverticulum. Rates are lower for distal repairs and higher for proximal or redo cases.

  • Will my child have normal function as an adult?

    Most men who have had distal hypospadias repair have a normal urinary stream, normal erections and normal fertility. Proximal or redo cases have more variable outcomes, which is why long-term follow-up into adolescence and adulthood at a specialist centre is important.

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