hypospadias

File:Wax human hermaphrodit genital 2.jpg and hypospadias]]

A penis with hypospadias usually has a characteristic appearance. Not only is the meatus (urinary opening) lower than usual, but the foreskin is also often only partially developed, lacking the usual amount that would cover the glans on the underside, causing the glans to have a hooded appearance. However, newborns with partial foreskin development do not necessarily have hypospadias, as some have a meatus in the usual place with a hooded foreskin, called "chordee without hypospadias".{{cite journal |vauthors=Singh S, Rawat J, Kureel SN, Pandey A |title=Chordee without hypospadias: Operative classification and its management |journal=Urol Ann |volume=5 |issue=2 |pages=93–8 |date=April 2013 |pmid=23798865 |pmc=3685753 |doi=10.4103/0974-7796.110005 |doi-access=free }}

In other cases, the foreskin (prepuce) is typical and the hypospadias is concealed. This is called "megameatus with intact prepuce". The condition is discovered during newborn circumcision or later in childhood when the foreskin begins to retract. A newborn with typical-appearing foreskin and a straight penis who is discovered to have hypospadias after the start of circumcision can have circumcision completed without concern for jeopardizing hypospadias repair.{{cite journal |vauthors=Snodgrass WT, Khavari R |title=Prior circumcision does not complicate repair of hypospadias with an intact prepuce |journal=The Journal of Urology |volume=176 |issue=1 |pages=296–8 |date=July 2006 |pmid=16753427 |doi=10.1016/S0022-5347(06)00564-7}}{{cite journal |vauthors=Chalmers D, Wiedel CA, Siparsky GL, Campbell JB, Wilcox DT |title=Discovery of hypospadias during newborn circumcision should not preclude completion of the procedure |journal=The Journal of Pediatrics |volume=164 |issue=5 |pages=1171–1174.e1 |date=May 2014 |pmid=24534572 |doi=10.1016/j.jpeds.2014.01.013}}

There is noted to be an increase in erectile problems in people with hypospadias, particularly when associated with a chordee (down curving of the shaft). There is usually minimal interaction with ability to ejaculate in hypospadias providing the meatus remains distal. This can also be affected by the coexistence of posterior urethral valves. There is an increase in difficulties associated with ejaculation, however, including increased rate of pain on ejaculation and weak/dribbling ejaculation. The rates of these problems are the same regardless of whether or not the hypospadias is surgically corrected.

Hypospadias is present at birth, although the cause of hypospadias remains unknown. The influence of genes and the intrauterine environment have been proposed. Sexual differentiation of males and female fetuses occurs under the influence of prenatal sex hormones. In humans, the development of external genitalia occurs in during an early hormone independent phase (5 to 8 weeks of gestation) and a later hormone dependent stage (weeks 8 to 12). One hypothesis proposes that atypical androgen exposure, or interference in the differentiation process, produces hypospadias.{{Cite journal |last1=Bouty |first1=Aurore |last2=Ayers |first2=Katie L. |last3=Pask |first3=Andrew |last4=Heloury |first4=Yves |last5=Sinclair |first5=Andrew H. |date=2015-11-28 |title=The Genetic and Environmental Factors Underlying Hypospadias |url=https://doi.org/10.1159/000441988 |journal=Sexual Development |volume=9 |issue=5 |pages=239–259 |doi=10.1159/000441988 |pmid=26613581 |issn=1661-5425 |pmc=5012964}}

When one identical twin is born with hypospadias, his identical twin also has the trait only 25% of the time, despite sharing their genes and prenatal hormonal environment.{{Cite journal |last1=Rice |first1=William R. |last2=Friberg |first2=Urban |last3=Gavrilets |first3=Sergey |date=2012 |title=Homosexuality as a Consequence of Epigenetically Canalized Sexual Development |url=http://scottbarrykaufman.com/wp-content/uploads/2012/12/Rice-et-al.-2012.pdf |journal=The Quarterly Review of Biology |language=en |volume=87 |issue=4 |pages=355–356 |doi=10.1086/668167 |pmid=23397798 |issn=0033-5770}} Animal studies have found that androgen antagonists during early fetal development cause elevated rates of hypospadias and cryptorchidism, however, in humans these traits rarely occur together. In addition, levels of circulating testosterone overlap for both male and female fetuses throughout fetal development. Rice et al. have proposed that sexually dimorphic development occurs through epigenetic markers which are laid down during stem cell development, which blunt androgen signalling in XX fetuses, and boost sensitivity in XY fetuses.{{Cite journal |last=Rice |first=William R. |last2=Friberg |first2=Urban |last3=Gavrilets |first3=Sergey |date=2016 |title=Sexually antagonistic epigenetic marks that canalize sexually dimorphic development |url=http://volweb2.utk.edu/~gavrila/papers/mol_ecol_16.pdf |journal=Molecular Ecology |language=en |volume=25 |issue=8 |pages=1812–1822 |doi=10.1111/mec.13490 |issn=0962-1083}} If this marks are sexually antagonistic, and if a subset of these epigenetic marks carry over generations, they are expected to produce mosaicism of sexual development in opposite-sex offspring, sometimes producing hypospadias or cryptorchidism when passed from a mother to son (feminizing the external genitalia). Two small sample studies in 2012 and 2013 found changes in the transcriptome and methylome of hypospadias patients. A 2022 study found additional evidence of atypical epigenetic methylation in foreskin tissue of hypospadias patients.{{Cite journal |last1=Kaefer |first1=Martin |last2=Rink |first2=Richard |last3=Misseri |first3=Rosalia |last4=Winchester |first4=Paul |last5=Proctor |first5=Cathy |last6=Ben Maamar |first6=Millissia |last7=Beck |first7=Daniel |last8=Nilsson |first8=Eric |last9=Skinner |first9=Michael K. |date=2023-01-11 |title=Role of epigenetics in the etiology of hypospadias through penile foreskin DNA methylation alterations |journal=Scientific Reports |language=en |volume=13 |issue=1 |pages=555 |doi=10.1038/s41598-023-27763-5 |issn=2045-2322 |doi-access=free |pmid=36631595 |pmc=9834259 |bibcode=2023NatSR..13..555K}} Rice's model requires further testing with currently available technology to support or falsify it.

{{Intersex sidebar}}

Where hypospadias is seen as a genital ambiguity in a child, the World Health Organization standard of care is to delay surgery until the child is old enough to participate in informed consent, unless emergency surgery is needed because the child lacks a urinary opening. Hypospadias is not a serious medical condition. A urinary opening that is not surrounded by glans tissue is more likely to "spray" the urine, which can cause a person to sit to urinate because they cannot reliably stand and hit the toilet. Chordee is a separate condition, but where it occurs, the downward curvature of the penis may be enough to make sexual penetration more difficult. For these reasons or others, people with hypospadias may choose to seek urethroplasty, a surgical extension of the urethra using a skin graft. {{citation needed|date=April 2021}}

Surgery can extend the urinary channel to the end of the penis, straighten bending, and/or change the foreskin (by either circumcision or by altering its appearance to look more typical ("preputioplasty"), depending on the desire of the patient. Urethroplasty failure rates vary enormously, from around 5% for the simplest repairs to damage in a normal urethra by an experienced surgeon, to 15-20% when a buccal graft from the inside of the mouth can be used to extend a urethra, to close to 50% when graft urethral tubes are constructed from other skin.{{Cite web |url=http://www.columbiaurology.org/urethroplasty |title=Urethroplasty |date=2016-06-06 |website=Department of Urology |language=en |access-date=2019-06-14 |archive-url=https://web.archive.org/web/20240526012334/https://www.columbiadoctors.org/specialties/urology/treatments/urethroplasty |archive-date=2024-05-26}}

When the hypospadias is extensive–third degree/penoscrotal–or has associated differences in sex development such as chordee or cryptorchidism, the best management can be a more complicated decision. The world standard (UN and WHO) forbids nonessential surgery to produce a "normal" appearance without the informed consent of the patient,{{Cite web|url=https://www.unfe.org/wp-content/uploads/2017/05/UNFE-Intersex.pdf|title=United Nations Fact Sheet-Intersex}} and the American Academy of Pediatrics currently recommends but does not require the same standard. The AAP Textbook of Pediatric Care states "Gender assignment in patients with genital ambiguity should be made only after careful investigation by a multidisciplinary team; increasingly, surgical decisions are delayed until the child is able to participate in the decision-making process."{{Cite book |url=https://pediatriccare.solutions.aap.org/chapter.aspx?sectionId=123812175&bookId=1626&resultClick=1 |chapter=Disorders of Sex Development |title=American Academy of Pediatrics Textbook of Pediatric Care |edition=2nd |date=2017 |access-date= |last1=Loomba-Albrecht |first1=Lindsey A. |last2=Styne |first2=Dennis M. |isbn=978-1-61002-579-9}} A karyotype and endocrine evaluation should be performed to detect intersex conditions or hormone deficiencies that have major health risks (i.e. salt-wasting). If the penis is small, testosterone or human chorionic gonadotropin (hCG) injections may be given with consent to enlarge it before surgery if this will increase the chance of a successful urethral repair.

Surgical repair of severe hypospadias may require multiple procedures and mucosal grafting. Preputial skin is often used for grafting and circumcision should be avoided before repair. In patients with severe hypospadias, surgery often produces unsatisfactory results, such as scarring, curvature, or formation of urethral fistulas, diverticula, or strictures. A fistula is an unwanted opening through the skin along the course of the urethra, and can result in urinary leakage or an abnormal stream. A diverticulum is an "outpocketing" of the lining of the urethra which interferes with urinary flow and may result in posturination leakage. A stricture is a narrowing of the urethra severe enough to obstruct flow. Reduced complication rates even for third-degree repair (e.g., fistula rates below 5%) have been reported in recent years from centers with the most experience.{{Cite web |url=https://www.parcurology.com/news-and-articles/re-operation-dr-nicol-bush-dr-warren-snodgrass-2/ |title=Re operation with Dr Nicol Bush & Dr Warren Snodgrass |date=2016-07-15 |website=PARC Urology Hypospadias Center |language=en-US |access-date=2019-05-09 |archive-url=https://web.archive.org/web/20240526013841/https://hypospadias.com/news-and-articles/re-operation-dr-nicol-bush-dr-warren-snodgrass-2/ |archive-date=2024-05-26}} However, typical complications in urethroplasty for severe hypospadias can lead to long surgical cycles of failure and repair, and side effects may include loss of sexual or urinary function.{{cite book |last1=Bayne |first1=Aaron P. |last2=Jones |first2=Eric A. |editor1-first=Samir S. |editor1-last=Taneja |title=Complications of Urologic Surgery |edition=4th |date=2010 |publisher=W.B. Saunders |isbn=978-1-4160-4572-4 |pages=713–722 |chapter-url=https://www.sciencedirect.com/science/article/pii/B9781416045724000601 |chapter=Complications of hypospadias repair}} Research suggests failure rates are higher when urethroplasty corrects a born condition rather than disease or injury{{cite journal |vauthors=Suh JG, Choi WS, Paick JS, Kim SW |title=Surgical Outcome of Excision and End-to-End Anastomosis for Bulbar Urethral Stricture |journal=Korean Journal of Urology |volume=54 |issue=7 |pages=442–7 |date=July 2013 |pmid=23878686 |pmc=3715707 |doi=10.4111/kju.2013.54.7.442}} so patients and families considering surgery for hypospadias should have realistic expectations about the risks and benefits.{{Cite web |url=https://www.issm.info/sexual-health-qa/what-are-some-of-the-risks-of-penile-surgery/ |title=What are some of the risks of penile surgery? |date=2012-02-21 |website=ISSM |language=en-GB |access-date=2019-06-14 |archive-url=https://web.archive.org/web/20240707015023/https://www.issm.info/sexual-health-articles#sort=published_date&sortdir=desc&attr.ct5.value=Men%25E2%2580%2599s%2520Sexual%2520Health&page=1 |archive-date=2024-07-07}}

The results of surgery are probably not influenced by the age at which repair is done.{{cite book |first=Warren T. |last=Snodgrass |author-link=Warren Snodgrass |title=Pediatric Urology: Evidence for Optimal Patient Management |url=https://books.google.com/books?id=6v7MpSAqbgcC&pg=PA117 |date=2013-05-13 |publisher=Springer Science+Business Media |isbn=978-1-4614-6910-0 |pages=117–}}{{cite journal |vauthors=Bush N, Snodgrass W |title=Response to "Re: Snodgrass W, et al. Duration of follow-up to diagnose hypospadias urethroplasty complications. J Pediatr Urol 2014;10:783-784" |journal=Journal of Pediatric Urology |volume=10 |issue=4 |pages=784–5 |date=August 2014 |pmid=24999242 |doi=10.1016/j.jpurol.2014.04.022}} Teens and adults typically spend one night in the hospital after surgery.{{citation needed|date=May 2021}}

Hormones potentially increase the size of the penis, and have been used in children with proximal hypospadias who have a smaller penis. Numerous articles report testosterone injections or topical creams increase the length and circumference of the penis. However, few studies discuss the impact of this treatment on the success of corrective surgery, with conflicting results.{{cite journal |vauthors=Kaplan GW |title=Does administration of transdermal dihydrotestosterone gel before hypospadias repair improve postoperative outcomes? |journal=Nature Reviews Urology |volume=5 |issue=9 |pages=474–5 |date=September 2008 |pmid=18679395 |doi=10.1038/ncpuro1178 |s2cid=22512786}}

Surgery is not always required for minor hypospadias like glanular hypospadias and coronal hypospadias if the meatus is of good caliber, urine flow is in good stream & forwardly directed.{{Cite web |title=Hypospadias |date=2020-08-31 |url=http://www.hypospadiasfoundation.com/hypospadias-blog-by-dr-a-k-singal/hypospadias-guide-for-pediatricians-and-healthcare-professionals/ |access-date=2023-03-21 |language=en |archive-url=https://web.archive.org/web/20230321091253/http://www.hypospadiasfoundation.com/hypospadias-blog-by-dr-a-k-singal/hypospadias-guide-for-pediatricians-and-healthcare-professionals/ |archive-date=2023-03-21}}

Hypospadias repair is done under general anesthesia, most often supplemented by a nerve block to the penis or a caudal block to reduce the general anesthesia needed, and to minimize discomfort after surgery.{{citation needed|date=April 2021}}

Many techniques have been used during the past 100 years to extend the urinary channel to the desired location. Today, the most common operation, known as the tubularized incised plate or "TIP" repair, rolls the urethral plate from the low meatus to the end of the glans. TIP repair, also called the Snodgrass Repair (after the creator of the method, Warren Snodgrass), is the most widely used procedure and surgical method for hypospadias repair worldwide. This procedure can be used for all distal hypospadias repairs, with complications afterwards expected in less than 10% of cases.{{cite journal |vauthors=Snodgrass WT, Bush N, Cost N |title=Tubularized incised plate hypospadias repair for distal hypospadias |journal=Journal of Pediatric Urology |volume=6 |issue=4 |pages=408–13 |date=August 2010 |pmid=19837000 |doi=10.1016/j.jpurol.2009.09.010}}{{cite journal |vauthors =Wilkinson DJ, Farrelly P, Kenny SE |title=Outcomes in distal hypospadias: a systematic review of the Mathieu and tubularized incised plate repairs |journal=Journal of Pediatric Urology |volume=8 |issue=3 |pages=307–12 |date=June 2012 |pmid=21159560 |doi=10.1016/j.jpurol.2010.11.008 }}

Less consensus exists regarding proximal hypospadias repair.{{cite journal |vauthors=Castagnetti M, El-Ghoneimi A |title=Surgical management of primary severe hypospadias in children: systematic 20-year review |journal=The Journal of Urology |volume=184 |issue=4 |pages=1469–74 |date=October 2010 |pmid=20727541 |doi=10.1016/j.juro.2010.06.044}} TIP repair can be used when the penis is straight or has mild downward curvature, with success in 85%. Alternatively, the urinary channel can be reconstructed using the foreskin, with reported success in from 55% to 75%.{{cite book |first=Warren T. |last=Snodgrass |author-link=Warren Snodgrass |title=Pediatric Urology: Evidence for Optimal Patient Management|url=https://books.google.com/books?id=6v7MpSAqbgcC&pg=PA129 |date=2013-05-13 |publisher=Springer Science+Business Media |isbn=978-1-4614-6910-0 |pages=129–}}

Most distal and many proximal hypospadias are corrected in a single operation. However, those with the most severe condition having a urinary opening in the scrotum and downward bending of the penis are often corrected in a two-stage operation. During the first operation the curvature is straightened. At the second, the urinary channel is completed. Any complications may require additional interventions for repair.{{citation needed|date=April 2021}}

File:Hypospadias3.jpg|Example of penis with hypospadias

File:Hypospadie Fisteln.jpg|Penis with hypospadias (1) and two fistulae (2)

File:Penis with Hypospadias. 01.jpg|Adult penis with hypospadias

File:Penis with Hypospadias. 02.jpg|Adult penis with hypospadias

File:Penis with repaired hypospadias2.jpg | Glans penis with hypospadias repaired as an adult

File:Penis with repaired hypospadias.jpg | Penis with hypospadias repaired as an adult

File:Erect penis with fully shaved pubic hair.jpg | Penis with hypospadias repaired as an adult - side view

Problems that can arise include a small hole in the urinary channel below the meatus, called a fistula. The head of the penis, which is open at birth in children with hypospadias and is closed around the urinary channel at surgery, sometimes reopens, known as glans dehiscence. The new urinary opening can scar, resulting in meatal stenosis, or internal scarring can create a stricture, either of which cause partial blockage to urinating. If the new urinary channel balloons when urinating a child is diagnosed with a diverticulum.{{citation needed|date=April 2021}}

Most complications are discovered within six months after surgery, although they occasionally are not found for many years. In general, when no problems are apparent after repair in childhood, new complications arising after puberty are uncommon. However, some problems that were not adequately repaired in childhood may become more pronounced when the penis grows at puberty, such as residual penile curvature or urine spraying due to rupture of the repair at the head of the penis.{{citation needed|date=April 2021}}

Complications are usually corrected with another operation, most often delayed for at least six months after the last surgery to allow the tissues to heal sufficiently before attempting another repair. Results when circumcision or foreskin reconstruction are done are the same.{{cite journal | vauthors = Suoub M, Dave S, El-Hout Y, Braga LH, Farhat WA | title = Distal hypospadias repair with or without foreskin reconstruction: A single-surgeon experience | journal = Journal of Pediatric Urology | volume = 4 | issue = 5 | pages = 377–80 | date = October 2008 | pmid = 18790424 | doi = 10.1016/j.jpurol.2008.01.215 }}{{cite journal | vauthors = Snodgrass W, Dajusta D, Villanueva C, Bush N | title = Foreskin reconstruction does not increase urethroplasty or skin complications after distal TIP hypospadias repair | journal = Journal of Pediatric Urology | volume = 9 | issue = 4 | pages = 401–6 | date = August 2013 | pmid = 22854388 | doi = 10.1016/j.jpurol.2012.06.008 }} (Figure 4a, 4b)

Patients and surgeons had differing opinions as to outcomes of hypospadias repair, that is, patients might not be satisfied with a cosmetic result considered satisfactory by the surgeon, but patients with a cosmetic result considered not very satisfactory by the surgeon may themselves be satisfied. Overall, patients were less satisfied than surgeons.{{cite journal |vauthors=Mieusset R, Soulié M |title=Hypospadias: psychosocial, sexual, and reproductive consequences in adult life |journal=Journal of Andrology |volume=26 |issue=2 |pages=163–8 |date=2005 |pmid=15713818 |doi = 10.1002/j.1939-4640.2005.tb01078.x |doi-access=free}}

Living with hypospadias can present challenging emotional obstacles. Many men, whether they have had surgical repair of their hypospadias as a child or not often are very guarded in school bathrooms or locker rooms. Secrecy about the condition can complicate emotional pain, because talking about the penis is often a taboo subject. Worry, anxiety and feelings of shame are common among adult men born with hypospadias.{{Cite book |last=Filippelli |first=John |title=Living With Hypospadias |publisher=Palmetto Publishing |year=2021 |isbn=978-1638372172 |pages=24–30}}

Hypospadias is among the most common birth defects in the world and is said to be the second-most common birth defect in the male reproductive system, occurring once in every 250 males.{{cite web |last=Gatti |first=John M |name-list-style=vanc |title=Epidemiology |url=http://emedicine.medscape.com/article/1015227-overview#a0199 |publisher=Medscape Reference |access-date=22 January 2013 |archive-url=https://web.archive.org/web/20240217025301/https://emedicine.medscape.com/article/1015227-overview#a0199?form=fpf |archive-date=2024-02-17}} At birth, it may affect as many as 1% of males, although prevalence may vary by country. When including milder cases, as many as 4% of males are affected.

Due to variations in the reporting requirements of different national databases, data from such registries cannot be used to accurately determine either incidence of hypospadias or geographical variations in its occurrences.

While most hypospadias repairs are done in childhood, occasionally, an adult desires surgery because of urinary spraying or unhappiness with the appearance.

A direct comparison of surgical results in children versus adults found they had the same outcomes, and adults can undergo hypospadias repair or reoperations with good expectations for success.

Notable individuals with hypospadias:

• Henry II of France{{Cite web |title=The "infertility" of Catherine de Medici and its influence on 16th century France |url=https://www.canjurol.com/pdfs/DrGordetsky.pdf |archive-url=https://web.archive.org/web/20160413223559/https://www.canjurol.com/pdfs/DrGordetsky.pdf |archive-date=2016-04-13}}
• Tiger Devore{{cite news |url=https://www.bbc.co.uk/news/health-14459843 |title=Male or female? Babies born on the sliding sex scale |work=BBC News |date=11 October 2011 |access-date=2016-05-12 |archive-url= |archive-date=}}{{Cite news |last=Littlefield |first=Amy |title =Intersex People Want to End Nonconsensual Surgeries. A California Resolution Is Their 'Warning Shot.' |work=Rewire.News |access-date=2018-11-30 |date=August 13, 2018 |url=https://rewire.news/article/2018/08/13/intersex-people-want-to-end-nonconsensual-surgeries-a-california-resolution-is-their-warning-shot/ |archive-url= |archive-date=}}
• Gabriel J. Martín[https://www.abc.es/sociedad/20141020/abci-intersexualidad-cuerpos-enganan-201410170853.html Intersexualidad: «Nunca me sentí niña y mi comportamiento masculino era un problema».] ABC. 20 October 2014.[https://verne.elpais.com/verne/2016/06/24/articulo/1466781342_404833.html La barba me dio la razón: aunque me criaran como una niña, yo era un niño.] El País. 30 June 2016.
• Scout Schultz{{Cite news |issue=82 |last=Lieberman |first=Hallie |title=The Trigger Effect |work=The Atavist Magazine |access-date=2018-08-31 |date=2018-08-29 |url=https://magazine.atavist.com/the-trigger-effect-scout-schultz-georgia-tech |archive-url=https://web.archive.org/web/20180901113216/https://magazine.atavist.com/the-trigger-effect-scout-schultz-georgia-tech |archive-date=2018-09-01 |url-status=live}}
• Lil DickyHeifetz, Danny, [https://www.theringer.com/tv/2020/3/4/21164450/dave-lil-dicky-fxx-interview When a Dick Joke Isn't a Joke], theringer.com, March 2020
• Sa Bangji{{Cite web |title=조선왕조실록 |url=https://sillok.history.go.kr/main/main.do;jsessionid=4xGQQuQUt7BeodVL2IbdYtsZLNOJ6A5cD_RIbVfb.node20 |access-date=2025-03-05 |website=sillok.history.go.kr}}

• Pediatric urology
• Andrology
• Bladder exstrophy, cloacal exstrophy
• Pseudovaginal perineoscrotal hypospadias
• Intersex surgery
• Androgen insensitivity syndrome
• Testicular dysgenesis syndrome

{{Reflist}}

{{refbegin}}

• {{cite journal |vauthors=Austin PF, Siow Y, Fallat ME, Cain MP, Rink RC, Casale AJ |title=The relationship between müllerian inhibiting substance and androgens in boys with hypospadias |journal=The Journal of Urology |volume=168 |issue=4 Pt 2 |pages=1784–8; discussion 1788 |date=October 2002 |pmid=12352359 |doi=10.1016/S0022-5347(05)64413-8}}
• {{cite journal |vauthors=Patel RP, Shukla AR, Snyder HM |title=The island tube and island onlay hypospadias repairs offer excellent long-term outcomes: a 14-year followup |journal=The Journal of Urology |volume=172 |issue=4 Pt 2 |pages=1717–9; discussion 1719 |date=October 2004 |pmid=15371798 |doi=10.1097/01.ju.0000138903.20136.22}}
• {{cite journal |vauthors=Retik AB, Atala A |title=Complications of hypospadias repair |journal=The Urologic Clinics of North America |volume=29 |issue=2 |pages=329–39 |date=May 2002 |pmid=12371224 |doi=10.1016/S0094-0143(02)00026-5}}
• {{cite journal |vauthors=Shukla AR, Patel RP, Canning DA |title=Hypospadias |journal=The Urologic Clinics of North America |volume=31 |issue=3 |pages=445–60, viii |date=August 2004 |pmid=15313054 |doi=10.1016/j.ucl.2004.04.020}}
• {{cite journal |vauthors=Paulozzi LJ |title=International trends in rates of hypospadias and cryptorchidism |journal=Environ Health Perspect |volume=107 |issue=4 |pages=297–302 |date=April 1999 |pmid=10090709 |pmc=1566511 |doi=10.1289/ehp.99107297 }}
• {{cite journal |journal=Indian Journal of Urology |year=2008 |volume=24 |issue=2 |title=Special issue on hypospadias |url=http://www.indianjurol.com/showBackIssue.asp?issn=0970-1591;year=2008;volume=24;issue=2;month=April-June}}

{{refend}}

{{Commons category|Hypospadias}}

{{Medical resources

| ICD10 = {{ICD10|Q|54||q|54|}}

| ICD9 = {{ICD9|752.61}}

| DiseasesDB = 29907

| MedlinePlus = 001286

| eMedicineSubj = ped

| eMedicineTopic = 1136

| MeshID =

}}

{{Authority control}}

Category:Congenital disorders of urinary system

Category:Congenital disorders of male genital organs

Category:Penis

Category:Intersex variations