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Duke Children's pediatric urologists treat all types of hypospadias, including complex hypospadias. We offer the highest level of care, achieve excellent results, and give your child the best-possible start to help them feel confident and healthy.

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Hypospadias Care Based on Your Child’s Needs

What Is Hypospadias?
Hypospadias is a birth defect of the penis, in which the opening of the urethra -- the tube that urine flows through -- is on the underside of the penis, rather than at the tip. It usually affects the appearance of the foreskin and the direction of the urine stream; it can also cause the penis to curve downward (chordee). In severe hypospadias, the penis may be small (micropenis), and it can be difficult to tell whether the child has male or female genitals.

Goals of Care
When treating hypospadias, our team has three main goals:

  • Your child is able to stand up to urinate.
  • A straight penis with an opening at or near the tip to allow for normal sexual function and fertility in adulthood.
  • A good cosmetic appearance so the child has good self-esteem and better quality of life.

Surgery Isn't Always Necessary
Mild hypospadias doesn’t necessarily need surgery. This may be the case if normal urinary and sexual function will not be affected, and the difference in appearance is minimal. In some instances, parents wait until the child is older to have surgery. Waiting makes no difference in surgery success rates.

If Hypospadias Surgery Is Needed
When surgery is necessary, it is usually done between six and 18 months of age, when anesthesia is safe and the penis has completed its initial growth phase. Our pediatric urologists have advanced experience treating hypospadias, so we explain all your options and offer guidance to help you decide what’s right for your son.

Our Locations

Duke Health offers locations throughout the Triangle. Find one near you.



Hypospadias surgery repairs the urethra and relocates the opening to the tip of the penis. The actual procedure will vary depending on where the urinary opening is on the penis and what needs to be repaired. If curvature of the penis is present, that will be corrected at the same time. Your pediatric urologist will explain the procedure and what to expect during recovery. Most hypospadias surgeries are performed as outpatient procedures, with no overnight hospital stay necessary. In severe cases, two surgeries separated by six months may be planned to achieve the best results. Often, a small tube (catheter) will be left in place for a few days after surgery to allow proper healing. This tube will simply drain into a diaper and can be removed in clinic. 

Treatment for Micropenis

In some cases with very small penises, testosterone injections may be recommended for several months prior to surgery in order to stimulate growth of the penis. This may allow our surgeons to achieve better results after surgery.

Pain Management After Surgery

We know how difficult it is when your child is in pain, so we take pain control very seriously. We perform a nerve block during surgery to minimize pain both during and after surgery. After surgery, your child will return home with a pain regimen of medications to minimize pain to make them as comfortable as possible during the healing process. The surgical care team will give you detailed instructions about how to give your child pain medicine.

Surgery for Young Adults

Our urologists and gender-care team offer comprehensive treatment, counseling, and emotional support to young adults who are concerned about appearance, urinary stream, fertility, or sexual function. We also help young adults who had surgery as infants and are unhappy with the results. 

Complex Reconstruction

Our pediatric urologists specialize in repairing severe hypospadias that may require multiple surgeries -- whether it’s to repair an earlier, failed procedure or because your child has very complex anatomy. We develop a surgical treatment plan to meet your child’s needs and offer support throughout the process. Complication rates from this type of complex repair can be as high as 50% to 80% at some centers, but our complication rates are less than 10% for even the most difficult surgeries.  

Choosing a Center for Hypospadias Surgery

Performing the surgery correctly the first time prevents the need for multiple corrective procedures. That’s why it’s so important to work with pediatric urologists who have experience treating hypospadias.

Low Complication Rate
Our pediatric urologists treat a large number of severe hypospadias for a center of our size while maintaining a very low complication rate.  

Experienced Surgeons
Our experienced surgeons and pediatric anesthesiologists make surgery as safe and comfortable as possible for your child. Duke Children’s has been certified as a Level I Verified Children’s Surgery Center by the American College of Surgeons. This designation recognizes our commitment to providing the safest and highest-quality surgical care to our young patients.

Gender Care Team
If your child’s sex is unclear or ambiguous, your child’s care team will include a pediatric urologist and gender specialists to ensure your child has comprehensive care, including psychological support for children and parents. Our gender care team includes pediatric endocrinologists, social workers, and behavioral health counselors. We work collaboratively with other specialists in fertility, voice care, and other areas to support your child’s overall health and development.

Successful Corrective Surgeries
Our pediatric urologists care for children of all ages, from infants to older kids. We repair unsuccessful surgeries that were completed elsewhere and work with young adults who decide they want corrective surgery.

Personalized Care Plan
No matter your child’s age, we design a personalized care plan that includes emotional support and assistance from our dedicated team.

Child Life Specialists
Surgery can be frightening for kids. Our child life specialists can help explain the surgery, so your child knows what to expect, and help your child feel better through play learning, fun activities, and encouragement. 

Best Children's Hospital in NC

Duke Children's Hospital & Health Center is proud to be nationally ranked in 10 pediatric specialties.

This page was medically reviewed on 04/02/2024 by