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PubMed This is a summary of 60 peer-reviewed journal articles Updated
Pediatric Urology · Posterior Hypospadias

Understanding Posterior Hypospadias: A Guide for Parents

At a Glance

Posterior hypospadias is a complex condition where a male infant's urethral opening is located near or on the scrotum, often accompanied by penile curvature (chordee). It requires specialized, sometimes multi-stage, surgical repair by a pediatric urologist to restore normal function.

Finding out your newborn has posterior hypospadias can be an overwhelming experience. Many parents describe feeling a deep sense of worry and distress about their child’s future health and well-being after receiving the diagnosis [1]. It is important to know that these emotions are a natural response to a complex medical situation [2]. While this is a more involved form of the condition, modern specialized care and structured support can significantly reduce anxiety and help families navigate the path forward [3][4].

This guide provides a comprehensive overview of your child’s diagnosis and treatment path:

01

The Diagnostic Journey: Why DSD Testing Matters

Learn why DSD testing is often recommended for severe posterior hypospadias. Understand genetic tests, hormone evaluations, and what the results mean.

02

The Path to Repair: Surgical Strategies and Planning

Learn about surgical strategies for posterior hypospadias, including staged vs. single-stage repairs, hormone stimulation, and choosing the right surgeon.

03

The Long Road Ahead: Recovery, Complications, and Adult Life

Learn about recovery after posterior hypospadias repair. Understand common complications like fistulas, long-term monitoring, and outcomes for adult life.

Understanding the Terms

The word hypospadias describes a condition where the opening of the urethra (the tube that carries urine) is not at the tip of the penis. In posterior (also called proximal) hypospadias, the opening is located further back toward the body [5].

  • Posterior (Proximal): This is the rarest and most severe form of hypospadias [5][6]. It means the opening is located at the junction of the penis and scrotum (penoscrotal), on the scrotum itself (scrotal), or behind the scrotum (perineal) [5].
  • Non-syndromic (Isolated): This means the hypospadias occurred on its own, without any other birth defects, recognizable syndromes, or major chromosomal issues [7][8]. Doctors confirm this through a physical exam to ensure there are no other health concerns, such as undescended testes [9].
  • Chordee: This is a common feature of posterior hypospadias where the penis has a downward curve (ventral curvature) [10]. Straightening this curve is a vital part of the surgical repair [11].

How It Happens

During early pregnancy (the first trimester), the penis begins to form. In a typical development, two layers of tissue called urethral folds zip together to form the tube of the urethra [12].

Hypospadias occurs when this “zipping” process is interrupted [12]. In posterior cases, the fusion stops early, leaving the opening further back [5]. This is usually a multifactorial event, meaning it is caused by a complex mix of genetic factors, the environment, and the hormones (androgens) that signal the body to complete the zipping process [7][12][13].

Why Specialized Care is Essential

Because posterior hypospadias is complex and often involves significant curvature (chordee), it requires a high level of surgical expertise [14][10].

  • Surgical Complexity: Repairs for this form are more involved than for milder (distal) forms and may require a multi-stage approach rather than a single surgery [14][15].
  • Expertise Matters: Research shows that outcomes are often better when the repair is performed by fellowship-trained pediatric urologists at centers that handle a high volume of these specific cases [16][15].
  • Long-Term Outlook: While the road may involve more steps, many children go on to have successful functional outcomes, including a normal urinary stream [17][18]. Your care team will focus on both the appearance and the function of the penis to ensure the best long-term results [19].

Common questions in this guide

What does posterior hypospadias mean?
Posterior hypospadias is a severe form of the condition where the urethral opening is located far back from the tip of the penis, such as near or on the scrotum. It often occurs with a downward bend in the penis known as chordee.
What causes non-syndromic posterior hypospadias?
It is caused by an interruption in the normal development of the penis during the first trimester. This is usually due to a complex mix of genetic, environmental, and hormonal factors rather than a single identifiable syndrome.
Will my child need multiple surgeries for posterior hypospadias?
Because this is a complex condition that often involves significant penile curvature, correction frequently requires a multi-stage surgical process. A specialized pediatric urologist will determine the safest and most effective timeline based on your child's anatomy.
What is chordee and how is it treated?
Chordee is a downward curvature of the penis that commonly occurs alongside severe hypospadias. Straightening this curve is a vital part of the surgical repair to ensure proper long-term function and appearance.
What does it mean if the hypospadias is non-syndromic?
Non-syndromic means that the hypospadias occurred as an isolated event, without any other birth defects or major chromosomal issues. Your doctor will confirm this through a physical exam to ensure there are no other underlying health concerns.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Given the 'posterior' location, does my son also have 'chordee' (penile curvature), and how severe is it?
  2. 2.What specialized training do you have in repairing this specific, more complex form of hypospadias?
  3. 3.Are my son's testes fully descended, and does this change how we approach his diagnosis?
  4. 4.Since this is a non-syndromic case, what is the likelihood that future siblings might also be born with hypospadias?
  5. 5.Will my son need a single surgery or a multi-stage process to correct the opening and any curvature?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (19)
  1. 1

    Parental Concerns of Boys with Hypospadias.

    Snodgrass P, Snodgrass W, Bush N

    Research and reports in urology 2021; (13()):73-77 doi:10.2147/RRU.S285626.

    PMID: 33604312
  2. 2

    Penile appearance after hypospadias correction from a parent's point of view: Comparison of the hypospadias objective penile evaluation score and parents penile perception score.

    Haid B, Becker T, Koen M, et al.

    Journal of pediatric urology 2016; (12(1)):33.e1-7.

    PMID: 26725130
  3. 3

    Impact of an integrated disease-specific nursing care model on parental anxiety and depression in severe hypospadias patients in China: a randomized controlled trial.

    Wu R, Jia L, Ding B, et al.

    Journal of Korean Academy of Nursing 2025; (55(3)):327-341 doi:10.4040/jkan.24147.

    PMID: 40878560
  4. 4

    The impact of audiovisual information on parental anxiety levels prior to hypospadias surgery: A prospective single center cohort study.

    Karaburun MC, Akıncı A, Kubilay E, et al.

    Journal of pediatric urology 2024; (20(4)):746.e1-746.e7 doi:10.1016/j.jpurol.2024.06.012.

    PMID: 38944628
  5. 5

    What should be next in lifelong posterior hypospadias: Conclusions from the 2023 ERN eUROGEN and EJP-RD networking meeting.

    Lammers RJM, Tsachouridis G, Andersson MK, et al.

    Neurourology and urodynamics 2024; (43(5)):1097-1103 doi:10.1002/nau.25305.

    PMID: 38289328
  6. 6

    Effectiveness of penile ventral curvature correction and the trend of hypospadias repair: a prospective study of the national center in China.

    Yang Z, Li J, Liu P, et al.

    BMJ paediatrics open 2023; (7(1)) doi:10.1136/bmjpo-2023-001984.

    PMID: 37463825
  7. 7

    Variants in 46,XY DSD-Related Genes in Syndromic and Non-Syndromic Small for Gestational Age Children with Hypospadias.

    Leitao Braga B, Lisboa Gomes N, Nishi MY, et al.

    Sexual development : genetics, molecular biology, evolution, endocrinology, embryology, and pathology of sex determination and differentiation 2022; (16(1)):27-33 doi:10.1159/000518091.

    PMID: 34518484
  8. 8

    Investigation of Y chromosome microdeletions in algerian children with hypospadias.

    Laouar R, Chellat-Rezgoune D, Touabti S, et al.

    Journal of pediatric urology 2025; (21(3)):644-650 doi:10.1016/j.jpurol.2025.01.027.

    PMID: 39924361
  9. 9

    Failure of Prenatal Ultrasonography to Identify Classic Bladder Exstrophy in a Heavily Screened Population.

    Dekalo A, Friedman M, Ben-Chaim J, Bar-Yosef Y

    Urology 2025; (200()):166-169 doi:10.1016/j.urology.2025.02.028.

    PMID: 40015483
  10. 10

    A meta-analysis comparing dorsal plication and ventral lengthening for chordee correction during primary proximal hypospadias repair.

    Babu R, Chandrasekharam VVS

    Pediatric surgery international 2022; (38(3)):389-398 doi:10.1007/s00383-022-05065-7.

    PMID: 35048166
  11. 11

    Urethral plate transection for chordee release in severe proximal hypospadias cases.

    Demirtas G, Ekberli G, Tagcı S, et al.

    Scientific reports 2025; (15(1)):15269 doi:10.1038/s41598-025-00079-2.

    PMID: 40312458
  12. 12

    Unraveling the Androgen Receptor's Role in Hypospadias: A Systematic Review and Meta-Analysis.

    Ko S, Malm-Buatsi E, Amato CM

    International journal of molecular sciences 2026; (27(2)) doi:10.3390/ijms27020718.

    PMID: 41596366
  13. 13

    Role of epigenetics in the etiology of hypospadias through penile foreskin DNA methylation alterations.

    Kaefer M, Rink R, Misseri R, et al.

    Scientific reports 2023; (13(1)):555 doi:10.1038/s41598-023-27763-5.

    PMID: 36631595
  14. 14

    Incidence and diagnoses of disorders of sex development in proximal hypospadias.

    Wong YS, Tam YH, Pang KKY, Yau HC

    Journal of pediatric surgery 2018; (53(12)):2498-2501 doi:10.1016/j.jpedsurg.2018.08.010.

    PMID: 30224237
  15. 15

    Meta-analysis comparing the outcomes of single stage (foreskin pedicled tube) versus two stage (foreskin free graft & foreskin pedicled flap) repair for proximal hypospadias in the last decade.

    Babu R, Chandrasekharam VVS

    Journal of pediatric urology 2021; (17(5)):681-689 doi:10.1016/j.jpurol.2021.05.014.

    PMID: 34099397
  16. 16

    The learning curve in proximal hypospadias repair.

    Hisamatsu E, Sugita Y, Haruna A, et al.

    Journal of pediatric urology 2021; (17(3)):330.e1-330.e6 doi:10.1016/j.jpurol.2021.01.005.

    PMID: 33526367
  17. 17

    Long-term functional outcomes after penoscrotal hypospadias repair: A retrospective comparative study of proximal TIP, Onlay, and Duckett.

    Hueber PA, Salgado Diaz M, Chaussy Y, et al.

    Journal of pediatric urology 2016; (12(4)):198.e1-6.

    PMID: 27318548
  18. 18

    Bulbospongiosus Muscle Reconstruction in Proximal Hypospadias: Post Pubertal Function and Patient Satisfaction.

    Hennayake S, Marei MM, De Silva A, et al.

    Journal of pediatric surgery 2025; (60(8)):162385 doi:10.1016/j.jpedsurg.2025.162385.

    PMID: 40419237
  19. 19

    Does parental opinion differ from the health care team regarding cosmesis after hypospadias repair?

    Costa E, Fraga JC, Salle JP, Rosito N

    Revista da Associacao Medica Brasileira (1992) 2021; (67(1)):33-38 doi:10.1590/1806-9282.67.01.20200062.

    PMID: 34161487

This guide is for informational purposes to help parents understand posterior hypospadias. Always consult a specialized pediatric urologist regarding your child's specific diagnosis and surgical treatment plan.

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