This post is sponsored by Lurie Children’s Hospital, but all of the opinions within are those of The Everymom editorial board.
"As a team full of boy moms, we are well-versed in feeling the pressures of entering uncharted territory. While there are certain scenarios you can try preparing for—like how to avoid diaper changing accidents or how to have the birds and the bees talk when they’re of age—a diagnosis of hypospadias or undescended testes (UDT) is likely not one of them.
If your child has been diagnosed with hypospadias, UDT, or both and is undergoing medical treatment soon, it’s natural to feel totally overwhelmed. To help you navigate your child’s next steps, we’ve built a resource to answer all your questions with our long-standing partners at Ann & Robert H. Lurie Children’s Hospital of Chicago. We asked their surgical experts in pediatric urology to share everything you need to know about the diagnosis and treatment of hypospadias and undescended testes to get you up to speed.
Meet the Expert
Earl Y. Cheng, MD
Division Head, Urology; Co-Head, Reconstructive Pediatric Urology; Founders’ Board Chair in Urology
Meet the Expert
James T. Rague, MD
Attending Physician, Urology; Member, Lurie Children’s Surgical Foundation Assistant Professor of Urology
What is the difference between hypospadias and undescended testes?
Undescended testes diagnosis
In undescended testes, a baby boy’s testes do not descend properly to the scrotum. In normal fetal development, the testes (or testicles) first appear in the abdomen at approximately the level of the kidney. Then, they begin to descend toward the scrotum, where they typically “arrive” by 36 to 38 weeks of pregnancy. When UDT is present, that descent down into the scrotum does not occur properly.
UDT affects approximately 1 percent of males and more commonly occurs in babies that are born prematurely. While UDT typically affects one singular testis, in 10 percent of cases, both testes are involved.
Once a child is born, doctors will confirm a UDT diagnosis through physical examination, which, in 80 percent of UDT cases, will reveal an empty scrotum and a testicle that can be felt in the groin. If the undescended testis is not located in the groin, it may be in the abdominal cavity or elsewhere. Your doctor will discuss the next steps with you based on the location of the testicle and the age of your baby. In some cases, blood tests or hormonal tests may be needed to rule out other medical conditions that could be related to the undescended testes.
Hypospadias diagnosis
Hypospadias is a structural difference of the urinary tract that affects 0.5 percent of male infants. With this condition, the urinary opening is located on the underside of the penis rather than at the tip. The exact location of the misplaced opening on the underside of the penis can vary, but in more than two-thirds of cases, the defect is located near just below the head of the penis or along penile shaft. In more severe forms of hypospadias, the opening is located further down on the penile shaft (towards the scrotum) or below the scrotum.
Hypospadias is often associated with chordee, a condition where the penis curves in a downward direction. There are three different types and severities of hypospadias:
- Distal (closer to the tip): The most common and mildest form, with the urethral opening near the tip of the glans (head) of the penis or just below the glans.
- Midshaft: Opening occurs along the middle shaft of the penis.
- Proximal (closer to the torso): The most severe form where the opening is at the junction of the penis and scrotum or on the underside of the scrotum. This type often has the most severe degree of penile curvature.
Hypospadias is typically diagnosed during a physical examination shortly after birth. Doctors are trained to identify the characteristic signs of hypospadias, such as an atypically located urinary opening, incomplete foreskin on the underside of the penis, and downward curvature of the penis.
Do hypospadias and UDT usually present together?
According to the pediatric urology experts at Lurie Children’s, a patient can either have an isolated UDT, an isolated hypospadias, or both at the same time. When a child has both UDT and hypospadias together, it may raise an alarm as to whether there is another condition to be explored, leading to further medical assessment and evaluation. In cases where the two present together but the hypospadias accompanying the UDT is mild, the medical team is typically less concerned about an underlying diagnosis and may just look at correcting the two as isolated conditions.
What is the treatment for undescended testes?
If the testis has not reached the scrotum by 6 months of age and the diagnosis of UDT has been made, surgical correction will be recommended by the medical team. Performing this surgery between 6 and 18 months of age is ideal to reduce the risk of long-term effects of abnormal development, which when left untreated, could lead to issues with function, fertility, and testicular health.
What does UDT surgery look like?
The surgery for undescended testes, called orchiopexy, involves repositioning the testicles into the scrotum. The type of surgery will be dependent on the location of the testicle, but no matter the approach, general anesthesia will be used so that your child is asleep and unaware of the procedure.
For testicles that are located in the groin, two incisions will generally be made. The first small incision will be made in the groin to locate the testicle and to free it from surrounding tissues. The second small incision will be made in the scrotum so that the surgeon can pull the testicle down and anchor it in the correct spot with stitches.
When the testicle is in the abdominal cavity, a minimally invasive procedure known as laparoscopic surgery may be required to successfully locate and move the testicle into the scrotum. In this approach, incisions are made in the abdomen to allow the surgeon to insert a camera and surgical instruments to perform the surgery.
Depending on the complexity of the case, surgery usually takes one to two hours. In most cases, the procedure has excellent results with post-surgical fertility rates of around 90 percent (for children with a single UDT) and 80 percent (for UDT on both sides).
What is the treatment for hypospadias?
The decision to proceed with hypospadias repair is a decision that is made between a family and their medical team. Hypospadias repair is not required, but there are some reasons why repair may be chosen. These reasons include to allow for restoration of typical urinary function, typical cosmetic appearance, and possible psychological reasons. The two major functional reasons to perform surgery are 1) to correct deflection of the urinary stream to allow an individual to stand to pee and 2) to correct penile curvature to prevent potential sexual dysfunction later in life. From a cosmetic standpoint, surgery allows the urethral opening to be moved to the typical location in the head of the penis. Beyond functional and cosmetic concerns, parents and their medical team also consider the potential psychological repercussions and the child’s perception of the genitalia later in life if the condition is left untreated.
What does hypospadias surgery look like?
Like UDT surgery, this surgical procedure will also require the administration of general anesthesia. In cases of hypospadias where the opening is located closer to the tip of the penis, the opening defect and associated curvature can generally be corrected in a single outpatient operation. In these instances, more than 90 percent of the surgeries are successful. However, in more severe cases, two or more surgeries may be required to correct the penile curvature and move the opening of the urethra. In these severe cases, overall success rates are lower, and surgical complications are greater.
In some scenarios, your surgeon may elect to pretreat your child with male hormone treatments in the form of a topical cream or injections. This treatment will temporarily enlarge the penis and increase its blood supply, enhancing the ability to achieve a successful surgical result. The use of this preoperative hormone treatment is reversible and is safe.
What to expect after hypospadias and UDT surgery:
In most cases, children will go home from the recovery room on the day of surgery. While stitches will be necessary, your surgeon will likely use stitches that dissolve on their own and do not require removal.
After hypospadias surgery, children will have a bandage on their penis for a few days. In most cases, a small catheter will be left in the penis through which the urine will drain. The catheter generally remains in place for 1-2 weeks after surgery. It’s normal for them to experience some pain and discomfort, which can be managed with pain medications like Tylenol and Motrin. There will be restrictions on strenuous activity for several weeks to allow for healing (like sports or gym classes for older children).
Your child’s medical team will schedule follow-up appointments to monitor progress and ensure proper healing. Your providers may also recommend continuing regular checkups for the next few years to help ensure any physical and psychosocial concerns are being heard and treated.
Possible long-term effects:
Lurie Children’s pediatric urology team stressed that the long-term outlook for children with these conditions is generally positive. Nonetheless, surgical complications do occur, especially in the more severe forms of hypospadias. Children who have the correction of hypospadias should be expected to be followed by a urologist long-term to make sure they don’t develop complications, and if they do, doctors can intervene early.
Large pediatric hospitals like Lurie Children’s have vast experience in caring for these conditions. Additionally, there are psychosocial resources available for children and their families when needed. Using those resources, along with following the at-home care plan provided by your child’s medical team, can help ensure that your child is well-adjusted and healthy. With appropriate care, children with hypospadias and UDT live full lives with no limitations.
How to best prepare for treatment:
For parents of infants, the team at Lurie Children’s recommends becoming familiar with your child’s medical team and adhering to their advice. Ask if they recommend local support groups or can connect you with other families who have undergone similar procedures. The more information and support you equip yourself with, the less worrisome this experience can feel.
In cases where surgery is being pursued and the child is of an age to discuss it, it’s important that they can be involved in a developmentally appropriate way. Having your baby or child undergo surgery is never a walk in the park but you can rest assured these are procedures pediatric urologists are thoroughly trained in. Their teams equip parents with all the information they need to ensure a positive experience before, during, and after treatment.
About Ann & Robert H. Lurie Children’s Hospital of Chicago
Led by a team of world-renowned pediatrics experts, Lurie Children’s is the #1 pediatric hospital in Illinois and an institution we trust for all things kids’ health. With 140 years of clinical expertise, research, and community engagement, the team at Lurie Children’s is committed to putting children and their families at the center of everything they do. We are honored to partner with Lurie Children’s to help educate our readers about how we can help our kids lead a healthier future. Learn more about Lurie Children’s and find a doctor near you today!
This post was in partnership with Ann & Robert H. Lurie Children’s Hospital of Chicago, but all of the opinions within are those of The Everymom editorial board.