Hypospadias is a term describing a common malformation of the male urethra. The malformation is due to an abnormal development of the penis and the three main characteristics are: the urethra opens on the underside of the penis directing the urinary flow downwards, an open hooded foreskin that exposes the glans and urethral opening, and sometimes a curved penile body.
Proxial hypospadias is a more severe form of hypospadias where the urethral opening is located at the scrotum or the perineum. In these cases, the abnormality also includes a downward curvature of the penis, often accentuated at erection. Sometimes the condition is associated with non-descended testicles and in these cases, the boy might have to be subjected to further investigations within a specialised team dealing with Disorders of Sexual Development (commonly abbreviated DSD).
The treatment is surgical reconstruction. The aim of the surgical correction is to attain both a good function and a good appearance. It is important to straighten the curvature of the penis in order to procure a straight erection and the reconstruction also aims at a good and frontwards directed urinary stream.
Due to the severity of these abnormalities, sometimes more extensive reconstructions are needed and sometimes in several steps. After surgical correction of proximal hypospadias, complications can occur like fistula and a narrow urethra, which sometimes require further interventions. It is important to follow the boy up till puberty and sometimes also later in adulthood to secure a good sexual function and fertility and an overall satisfaction with the results.