Hypospadias, sometimes referred to as hypospade, is a birth defect in boys where the urethral opening is not at the end of the penis, but elsewhere along the urinary tract at the penis. This urethral defect is one of the most common birth defects in humans, with its prevalence estimated to be between 1 and 10 boys per 1000 births, according to sources. (1) (2) Doctors are sounding the alarm because, like other genital malformations such as the micropenis, its prevalence has increased sharply in recent decades and could be linked to overexposure to endocrine disruptors contained, for example in pesticides. This condition requires surgery.

The abnormal opening can form at different points in the urethra, between the tip of the penis and the scrotum. These different clinical forms of hypospadias are referred to as: balanic hypospadias (opening under the glans, the most common), penile hypospadias (opening in the middle of the penis), penoscrotal hypospadias (opening in the scrotum). There are different degrees of hypospadias, depending on the severity of the spongy divergence and therefore the size of the opening.

Hypospadias can be accompanied by other disorders: a micropenis, a curved penis, an abnormal urination of the urine requiring to sit down to urinate, testicular ectopia (a testicle is not completely descended into the scrotum).

Hypospadias is the result of a developmental defect during weeks 8-14 of pregnancy. It is due to insufficient masculinization of the baby boy’s genitals causing a divergence of the spongy body, the erectile part of the penis surrounding the urethra. In many cases, the cause of hypospasias is not identified. It would be a combination of genetic and environmental factors. However, it may be an inherited congenital malformation, but this familial form only represents 10% of all hypospasias cases. (1)

Several risk factors have been identified, such as the use of hormone progestin therapy during the first months of pregnancy, age (over 35 years) or the mother’s overweight. Recent studies implicate the in utero exposure of the fetus to certain endocrine disruptors, contained in particular in paints and solvents, detergents and pesticides. The results of a study conducted by the team of Charles Sultan, professor of pediatric endocrinology at the Montpellier University Hospital, caused a stir in the press.

Surgery, when necessary, is performed in the first few months of an infant’s life, usually between 3 and 18 months. Several types of surgery are possible, depending on the type and severity of hypospadias. Spongioplasty is often preferred. It can be done in several stages: correcting the spongy divergence, placing the urethral opening in the right place, correcting the curve of the penis, repairing the skin around the urethral opening. A baby with hypospadias should not be circumcised, as the foreskin can be used by the surgeon. Unoperated hypospadias can lead to problems, such as difficulty urinating while standing or having complicated interpretation of intercourse.