Hypospadias: What Parents Should Know Before Circumcision

Hypospadias is a condition present from birth in which the urethra does not reach the tip of the penis and opens somewhere on its underside. It is common in baby boys.

It is not a disease, and it is not the result of anything the parents did; development has simply not been completed. The answer to the question parents ask most — “did we do something wrong?” — is no.

Three findings are looked at together: where the opening is, whether the penis curves downwards, and how the foreskin is formed. When the opening is close to the tip, the condition is usually milder; when it is at the base of the penis or near the scrotum, a more extensive repair is needed.

A boy with hypospadias should not be circumcised before the repair. The foreskin is the most valuable tissue the surgeon can use; once it has been removed, the most suitable material is lost and the repair becomes harder. Tissue may then need to be taken from inside the mouth (a graft).

In families and communities where circumcision is customary, this is a common problem. If the position of your son’s urinary opening looks unusual, have a urologist see him before circumcision. Circumcision is usually planned during or after the repair.

No. The decision is not based on appearance alone. What matters is whether the boy can pass urine forwards, whether the stream sprays or points downwards, and whether the penis is clearly curved when passing urine or, later, during an erection.

Some boys whose opening is very close to the tip, with no curvature and no functional problem, may not need an operation. That is a valid outcome too, and parents are told so plainly.

Guidelines mostly favour the age of six to eighteen months. This period is chosen because the child will not remember it and healing is quick.

The repair can still be done later. There is no such thing as “too late”; only the planning changes.

In most cases where the opening is close to the tip, one stage is enough. In more severe cases where the opening is far back, or where tissue is lacking, a two-stage repair is usual: the curvature is corrected and the tissue prepared first, and the new channel is made in the second stage.

No surgeon can guarantee a final result in a single operation. An assessment that discusses the chance of a second procedure from the start is a realistic one.

A thin catheter is left in at the end of the operation and is usually removed after several days. After it comes out, the child’s first urine is watched; the stream should come out forwards, in a single jet.

The most common problem is a fistula: a small hole opens from the new channel to the skin, and some urine comes out there. Small fistulas sometimes close on their own; if not, a small operation is usually done after waiting a few months. This does not mean the first operation failed.

As the penis grows, curvature or narrowing may need to be looked at again. A check-up during puberty is normal for a boy repaired in childhood and is not a bad sign.

Plan to stay in Türkiye for around ten to fourteen days, because the catheter is removed and the first check is done here; more severe cases may need longer. Do not book your flight home for the day after the catheter comes out.

Send any previous operation notes and discharge summaries, a recent urine test, and a short video of your son passing urine. With these, the type of hypospadias and the likely number of stages can be assessed before you set off.

This article is general information and does not replace medical advice.