Hypospadias Clinical Presentation

Updated: May 15, 2017
  • Author: John M Gatti, MD; Chief Editor: Marc Cendron, MD  more...
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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 chordee.

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


Physical Examination

Although the diagnosis of hypospadias has been made with both antenatal fetal ultrasonography and magnetic resonance imaging (MRI), the diagnosis is generally made upon examination of the newborn infant. [15]

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 a proximally ectopic position. 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.

Chordee 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.