This is not an uncommon abnormality found in boys. An abnormal opening is present from birth and must be noticed by the parents soon after. The external urinary opening or the meatus, which is normally at the tip of the penis, is found to be on the lower side of the penis. This deformity is called Hypospadias. The site varies being either just below the tip, midway on the penis or very near the scrotum etc.



The importance of this anomaly is that this can cause 2 problems – firstly, passing urine in the standing position results in a poor stream and the urine falls on the boy’s feet or shoes. Thus, these boys have to squat and pass urine unlike their friends. Secondly, when the child gets an erection, the penis will be noticed to have a curvature facing downwards called chordee.



This chordee will cause difficulty in penetration later in life during sexual intercourse – indirectly affecting fertility and conception. Surgery ideally must be done around 1½ years of age. The operation required for correction of this deformity may be performed in 2 stages. The first stage involves straightening of the penis, correction of chordee. The second operation is performed 6 months later to construct the new urinary passage or urethra so that the new urinary opening is at the tip of the penis. After these operations, the child has a tube in the bladder to continuously drain urine. The tube is kept for 7 days, after which it is removed and the child passes urine on his own. The child is then sent home. At the end of the correction, the child is able to pass urine from the tip of the penis in standing position and able to have a normal projectile stream of urine.