Hypospadias is a condition in infant boys in which the opening that carries urine out of the body (the urethra) is on the underside, rather than the tip, of the penis. It’s a congenital condition, or present at birth, and that’s when you or your child’s doctor may first notice it.
There are different degrees of hypospadias, with the urethral opening appearing anywhere along the length of the penile shaft. Most are mild or moderate and a small percentage are severe. Hypospadias may cause your child to have a deflected urine stream.
There may also be other penile abnormalities associated with hypospadias. For example, the skin that covers the urethra is often thin and poorly developed and can result in bending of the penis, causing it to curve. This curvature is called a chordee. Although hypospadias may run in families, there’s no single known cause of the condition.
You might feel worried if your son is born with hypospadias, but you should know that it is a common condition. Nemours pediatric urologists are experienced at repairing the problem and restoring the appearance and function of your child’s penis.
Our Nemours urologists correct hypospadias with surgery that is usually performed when your son is older than 4 months of age. Depending on the severity of hypospadias, our doctor may perform straightening of the penis, relocation of the meatus (urethra opening) to the tip of the penis and the creation of a cosmetic glans (head of the penis) and penile shaft.
The goal of hypospadias repair is to normalize urination, create normal erections, and to improve the cosmetic appearance of the penis. The surgery is often same day surgery, and the overall results are excellent, with children going on to have normal urinary and sexual function in adulthood.
From Nemours' KidsHealth
- What Can I Do About My Child's Bedwetting?
- Recurrent Urinary Tract Infections and Related Conditions
- A to Z: Edema
- Urine Test: Protein
- Ultrasound: Renal (Kidneys, Ureters, Bladder)
- Urine Test: Calcium
- Urine Test: Creatinine
- A to Z: Neurogenic Bladder
- Kidneys and Urinary Tract
- A to Z: Cystitis
- Urine Test: Dipstick
- X-Ray Exam: Voiding Cystourethrogram (VCUG)
- Urinary Tract Infections
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Urinary Tract Infections
Urinary tract infections (UTIs) are common in kids. They happen when bacteria (germs) get into the bladder or kidneys.
A baby with a UTI may have a fever, throw up, or be fussy. Older kids may have a fever, have pain when peeing, need to pee a lot, or have lower belly pain.
Kids with UTIs need to see a doctor. These infections won't get better on their own. UTIs are easy to treat and usually clear up in a week or so.
Taking antibiotics kills the germs and helps kids get well again. To be sure antibiotics work, you must give all the prescribed doses — even when your child starts feeling better.
What Are the Signs of a UTI?
Most UTIs happen in the lower part of the urinary tract — the urethra and bladder. This type of UTI is called cystitis. A child with cystitis may have:
- pain, burning, or a stinging sensation when peeing
- an increased urge or more frequent need to pee (though only a very small amount of pee may be passed)
- waking up at night a lot to go to the bathroom
- wetting problems, even though the child is potty trained
- belly pain in the area of the bladder (generally below the belly button)
- foul-smelling pee that may look cloudy or contain blood
An infection that travels up the ureters to the kidneys is called pyelonephritis and is usually more serious. It causes many of these same symptoms, but the child often looks sicker and is more likely to have a fever (sometimes with shaking chills), pain in the side or back, severe tiredness, or vomiting.
Who Gets UTIs?
UTIs are much more common in girls because a girl's urethra is shorter and closer to the anus. Uncircumcised boys younger than 1 year also have a slightly higher risk for a UTI.
Other risk factors for a UTI include:
- a problem in the urinary tract (for example, a malformed kidney or a blockage somewhere along the tract of normal urine flow)
- an abnormal backward flow (reflux) of urine from the bladder up the ureters and toward the kidneys. This is known as vesicoureteral reflux (VUR), and many kids with a UTI are found to have it.
- poor toilet and hygiene habits
- family history of UTIs
UTIs are easy to treat, but it's important to catch them early. Undiagnosed or untreated UTIs can lead to kidney damage.
How Are UTIs Diagnosed?
To diagnose a UTI, health care providers ask questions about what's going on, do a physical exam, and take a sample of pee for testing.
How a sample is taken depends on a child's age. Older kids might simply need to pee into a sterile cup. For younger children in diapers, a catheter is usually preferred. This is when a thin tube is inserted into the urethra up to the bladder to get a "clean" urine sample.
The sample may be used for a urinalysis (a test that microscopically checks the urine for germs or pus) or a urine culture (which attempts to grow and identify bacteria in a laboratory). Knowing what bacteria are causing the infection can help your doctor choose the best treatment.
How Are UTIs Treated?
UTIs are treated with antibiotics. After several days of antibiotics, your doctor may repeat the urine tests to confirm that the infection is gone. It's important to make sure of this because an incompletely treated UTI can come back or spread.
If a child has severe pain when peeing, the doctor may also prescribe medicine that numbs the lining of the urinary tract. (This medication temporarily causes the pee to turn orange.)
Give prescribed antibiotics on schedule for as many days as your doctor directs. Keep track of your child's trips to the bathroom, and ask your child about symptoms like pain or burning during peeing. These symptoms should improve within 2 to 3 days after antibiotics are started.
Encourage your child to drink plenty of fluids, but avoid beverages containing caffeine, such as soda and iced tea.
Treatment for More Severe UTIs
Kids with a more severe infection may need treatment in a hospital so they can get antibiotics by injection or intravenously (delivered through a vein right into the bloodstream).
This might happen if:
- the child has high fever or looks very ill, or a kidney infection is likely
- the child is younger than 6 months old
- bacteria from the infected urinary tract may have spread to the blood
- the child is dehydrated (has low levels of body fluids) or is vomiting and cannot take any fluids or medicine by mouth
Kids with VUR will be watched closely by the doctor. VUR might be treated with medicines or, less commonly, surgery. Most kids outgrow mild forms of VUR, but some can develop kidney damage or kidney failure later in life.
Can UTIs Be Prevented?
In infants and toddlers, frequent diaper changes can help prevent the spread of bacteria that cause UTIs. When kids are potty trained, it's important to teach them good hygiene. Girls should know to wipe from front to rear — not rear to front — to prevent germs from spreading from the rectum to the urethra.
School-age girls should avoid bubble baths and strong soaps that might cause irritation, and they should wear cotton underwear instead of nylon because it's less likely to encourage bacterial growth.
All kids should be taught not to "hold it" when they have to go because pee that stays in the bladder gives bacteria a good place to grow. Kids should drink plenty of fluids and avoid caffeine, which can irritate the bladder.
Most UTIs are cured within a week with treatment.
When to Call the Doctor
Call your doctor immediately if your child has an unexplained fever with shaking chills, especially if there's also back pain or any type of pain when peeing.
Also call if your child has any of the following:
- bad-smelling, bloody, or discolored pee
- low back pain or belly pain (especially below the belly button)
- a fever of over 101°F (38.3°C) in children or 100.4°F (38°C) rectally in infants
Call the doctor if your infant has a fever, feeds poorly, vomits repeatedly, or seems unusually irritable.
Reviewed by: T. Ernesto Figueroa, MD
Date reviewed: May 25, 2017