Distal hypospadias is the least complex version of the condition, however, even the distal types can be complicated by the presence of significant penile curvature. Distal hypospadias repair is recommended for boys who don’t have any glans fusion (the glans is the name for the head of the penis) below the meatus. There are situations where the penis looks almost normal and a decision has to be made about recommending surgical repair or not. In these scenarios, it is our responsibility to present independent unbiased research material to help guide the parent in making their decision as there are adverse consequences to growing up with a penis that is not normal. The objective of surgical intervention is to normalize the abnormal anatomy that is present. Growing up with the abnormal anatomy of hypospadias is not without adverse consequences. We will discuss these adverse effects later below.

Though there may sometimes be controversy surrounding the necessity of repair for straightforward distal hypospadias, the more severe forms of the condition require no debate for repair as the meatus is significantly below the penis and invariably associated with penile curvature and other abnormalities.

Is hypospadias repair necessary?

The main objective of hypospadias repair is to correct abnormal anatomy. Thus, at the conclusion of the repair of a hypospadias condition, the surgeon seeks the outcome of a normal appearing penis that is straight with normal sexual function assuming there have been no factors to inhibit normal erectile function before surgery.
You may have been told in your journey seeking advice about your child’s condition that your child has a “minor” hypospadias that will need a simple operation to correct. Typically, the reference to a minor hypospadias is meant to convey the finding of a distal hypospadias where the meatus or “pee-hole” is either at the coronal level or subcoronal just behind the head of the penis underneath the penile shaft. The degree of fusion of the glans around the urethra (glans fusion) and the presence of penile curvature should also be checked as up to 30% thereabouts of distal hypospadias cases can have significant curvature. The decision to proceed or not proceed with repair then largely depends on your social circumstances and having access to a surgeon who obtains good results.

If your child has a “minor hypospadias” making you uncertain if surgery is needed or not, it is important that you as a parent be informed that a significant percentage of boys with untreated hypospadias will be at future risk for spraying of urine sporadically or continuously, pain with sexual intercourse and psychological issues revolving around an abnormal looking penis. For many, it has been observed that the spraying of urine with voiding usually starts around ages 8 to 12 years. In a study by renowned hypospadias surgeons Dr. Snodgrass and Dr. Nichol Bush of the Hypospadias Specialty Center in Dallas, Texas, they published that in 31 consecutive adults with uncorrected hypospadias:

• 80% had abnormal urinary spraying with voiding
• 40% were bothered by abnormal appearance of genitalia
• 36% had abnormal lateral (bend left or right) or ventral curvature (bend downward)
• 32% had sexual discomfort from irritation of the exposed urethra, penile curvature, or the presence of penoscrotal transposition