Hypospadias Clinical Presentation

Updated: Oct 04, 2023
  • Author: John Michael Gatti, MD; Chief Editor: Marc Cendron, MD  more...
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It is important to obtain a thorough history and physical examination, including any history of a familial pattern of hypospadias, any past medical history or comorbidity, and a physical assessment focusing on the meatal location, glans configuration, skin coverage, and ventral curvature (chordee).

A history of parental difficulties in conceiving and treatment should also be documented; in-vitro fertilization (IVF) has been associated with a higher incidence of hypospadias.


Physical Examination

Although the appearance of hypospadias has been identified with both antenatal fetal ultrasonography (US) and magnetic resonance imaging (MRI), the diagnosis is generally made upon examination of the newborn infant. [31]

A dorsal hood of foreskin and glanular groove are evident, but upon closer inspection, the prepuce is incomplete ventrally and the urethral meatus is noted in an abnormal proximal location. Rarely, the foreskin may be complete, and the hypospadias is revealed at the time of circumcision. If hypospadias is encountered during neonatal circumcision, after the dorsal slit has been performed, the procedure should be halted, and the patient should be referred for urologic evaluation.

Penile curvature may be readily apparent or may be discernible only during erection. Proximal hypospadias is commonly associated with a bifid scrotum and penoscrotal transposition (see the image below), in which the rugated scrotal skin begins lateral to the penis rather than in its normal posterior origin.

Penoscrotal transposition. Note rugated scrotal sk Penoscrotal transposition. Note rugated scrotal skin lateral to penis, cephalad to its normal position.