Hypospadias is one of the most common congenital conditions seen in boys, where the opening of the urethra (through which urine passes) is not located at the tip of the penis but rather somewhere along the underside. While this condition varies in severity, understanding its stages is essential for parents seeking clarity about treatment options.
In this blog, Dr. Apoorva Kulkarni, a compassionate and highly experienced Pediatric Surgeon, explains the key differences between Stage 1 and Stage 2 hypospadias, how they’re diagnosed, and when surgical correction may be necessary.
Understanding Hypospadias
In a normally developed penis, the urethral opening (meatus) is located at the tip of the glans. In boys born with hypospadias, this opening may be located:
- Just below the tip of the penis
- On the shaft
- Near the scrotum or perineum (in severe cases)
Additionally, hypospadias is often associated with:
- Chordee – a downward curvature of the penis
- Abnormal foreskin development (often called a “hooded” appearance)
- Spraying of urine due to improper direction
What Are the Stages of Hypospadias?
The term “stage” in hypospadias generally refers to the position of the urethral opening and the complexity of the condition. While staging can vary slightly among surgeons, the two commonly referred stages are:
Stage 1 (Distal Hypospadias)
Definition:
In this mildest form, the urethral opening is located near the head of the penis either just below the glans or on the shaft.
Features:
- Urethral opening near the tip
- Minimal or no chordee (curvature)
- Easier to correct surgically
- Typically good cosmetic and functional outcomes
- Child may still be able to urinate normally, but the stream may be slightly off-centered
Treatment:
- Surgery is often done between 6–18 months of age
- Usually a single-stage repair is sufficient
- Outpatient procedure in many cases
- High success rate with minimal complications
Stage 2 (Midshaft to Proximal Hypospadias)
Definition:
In this more complex form, the urethral opening is found further down the shaft, near the scrotum, or even between the scrotal folds.
Features:
- Urethral opening is midshaft or proximal
- Often associated with significant chordee
- More pronounced cosmetic deformity
- Increased difficulty in urination (spraying, discomfort)
- May impact fertility if not treated
Treatment:
- Often requires two-stage surgery or more complex reconstruction
- Timing of surgery remains the same (ideally before age 2)
- Long-term follow-up is required for monitoring urinary flow and penile development
- May require graft or flap techniques depending on severity
Does Every Child Need Surgery?
Not always. Some very mild cases of distal hypospadias may not require surgery, especially if:
- There is no curvature
- Urination is functional and pain-free
- Cosmetic appearance is acceptable to the parents
However, most cases benefit from corrective surgery especially if there is any difficulty in urination or future concern for sexual or reproductive health.
Long-Term Outlook
With modern surgical techniques, most children with hypospadias whether Stage 1 or Stage 2 go on to lead completely normal lives. Surgery aims to:
- Restore proper urinary function
- Correct penile curvature
- Improve appearance
- Preserve fertility and sexual function in the future
Dr. Apoorva Kulkarni is a skilled Pediatric Surgeon in Thane known for her gentle approach, surgical expertise, and child-focused care. With years of experience treating children with congenital urological conditions like hypospadias, He ensures:
- Accurate diagnosis and staging
- Family counseling and detailed explanation
- Minimal discomfort through pediatric-friendly anesthesia
- Excellent surgical outcomes with long-term support
Final Thoughts
Hypospadias is not just a cosmetic concern it can impact your child’s physical comfort and confidence as they grow. Understanding the difference between Stage 1 and Stage 2 hypospadias can help you make informed decisions about the best course of action.
If you suspect your child may have this condition, don’t wait. Early consultation leads to better outcomes.
For expert pediatric surgical care, book an appointment with:
Dr. Apoorva Kulkarni – Pediatric Surgeon in Thane
✅ Specializing in Hypospadias, Pediatric Urology, and Congenital Conditions