Snapshot A child is born with a urethral opening located between the tip of the glans penis and the base scrotum. Introduction Abnormality of anterior urethral and penile development Caused by congenital defect during development of the urethra Urethral opening is ectopically located on the ventral side of the penis proximal to the tip of the glans penis Urethral opening may be located in the scrotum or perineum Position of the urethral meatus defines the type of hypospadia Penis is more likely to have associated ventral shortening and curvature with more proximal defects May be associated with family history of the disorder or infertility treatment (IVF) Presentation Symptoms urination follows path of malpositioned urethral meatus Physical exam meatal location between tip of the glans and perineum glans configuration may be splayed open in distal cases skin coverage deficits must be noted chordee may be appreciated resulting in abnormal curvature of the penis Evaluation Diagnosis is based on clinical observation alone Family history familial transmission may be identified infertilty treatment should also be documented IVF has been associated with a higher incidence of hypospadias Differential Ambiguous genitalia, genital anomalies, error in circumcision Treatment Medical management none Surgical intervention surgical repair indicated in cases proximal (i.e. not adjacent to) from the glands penis may not be indicated in less severe cases multiple surgical approaches and methodology exist in the literature usually performed before 1 year of age Prognosis, Prevention, and Complications Prognosis ranges widely depending on location and severity of anatomic abnormality surgical outcomes range, but as surgical technique and microsurgery improves, future prognosis is expected to increase significantly Prevention none Complications post-surgical complications, meatal stenosis, urethral strictures/diverticula, recurrent urinary tract infections, permanent phallic malformation