Hypospadias in the neonate.

Hypospadias is a common developmental disorder of the urogenital tract, occurring in approximately 1 in 125 live male births. Defined as an atypical urethral opening anywhere along the shaft of the penis, scrotum, or perineum, hypospadias is often associated with a deficient prepuce and chordee. Hypospadias usually occurs as an isolated defect, but can be part of a recognized syndrome or associated with other genital anomalies. The etiology of nonsyndromic hypospadias is unknown, and is believed to be multifactorial. Recent studies have implicated factors such as familial inheritance, low birth weight, assisted reproductive technology, advanced maternal age, paternal subfertility, and endocrine-disrupting chemicals in the pathogenesis of hypospadias. Infants with hypospadias should not undergo circumcision. Currently, most infants with hypospadias undergo surgical reconstruction between 4 and 8 months of age. Parents of a newborn with hypospadias may be anxious and have many questions about their infant's condition. They should be given the opportunity to speak to a pediatric urologist as early as possible. This article provides a guide to the embryologic origins of hypospadias and a photographic atlas to aid bedside clinicians in identifying the spectrum of hypospadias in the newborn.