Hypospadias Detected on Second-Trimester Prenatal Screening: How We Help Hypospadias Babies Beat the Disease

Two years ago, Child Xiaojia was brought to the Department of Pediatric Surgery at Amcare Hangzhou for hypospadias treatment. Hypospadias is one of the severe congenital malformations of the male reproductive tract, defined by an abnormally positioned urethral opening on the ventral penis, scrotum or perineum instead of the glans tip, accompanied by penile curvature and irregular foreskin distribution. Without standardized repair, boys cannot stand to urinate normally; in adulthood, they may suffer painful erection, dyspareunia or infertility, while abnormal genital appearance severely damages self-identity and self-esteem.

Led by Director Xu Shan, the surgical team completed Xiaojia’s operation successfully. The full treatment journey from consultation and surgery to inpatient recovery earned the family’s complete trust in Amcare. Hence the couple chose our hospital without hesitation when planning their second pregnancy.

Unexpected Tulip Sign Found on Antenatal Ultrasound

The couple consulted Director Xu about hypospadias recurrence risk before conception. Hypospadias carries genetic predisposition: its baseline population incidence stands at roughly 3 per 1,000 live births, whereas households with one affected child face an elevated second-baby recurrence risk of 8%–10%. The couple underwent genetic and chromosomal testing with no abnormal findings identified.

Nevertheless, the unexpected emerged during the second-trimester four-dimensional ultrasound: the fetus presented the classic Tulip Sign, the pathognomonic prenatal ultrasonographic marker for severe hypospadias. The obstetric team immediately coordinated a joint consultation with Director Xu’s pediatric surgery group. Thanks to Xiaojia’s successful treatment experience, the parents stayed calm and trusted our team to accompany the unborn baby through treatment.

Younger Baby Xiaochen Gets Full Recovery

Xiaochen was delivered at full term at Amcare last year. On the very day of birth, our pediatric surgeons conducted urgent clinical assessment: the infant had underdeveloped external genitalia, ectopic urethral meatus and mild ventral penile curvature with dorsal hooded foreskin, consistent with a hypospadias diagnosis.

Given the infant’s mini-puberty (0–6 months of age with unique hormonal and developmental status), the team deferred surgical intervention and scheduled formal evaluation at six months old. At the six-month follow-up, moderate hypospadias with suboptimal penile development but acceptable penile straightening was confirmed. Director Xu customized an individual regimen: topical hormone ointment first to boost penile growth until glans diameter reached the 12-mm surgical cutoff, followed by definitive reconstructive surgery.

Xiaochen underwent successful repair at 10 months old with excellent postoperative recovery: fully straightened penis, anatomically normal urethral opening and smooth unobstructed urination. The external genital contour appears naturally neat similar to post-circumcision appearance, meeting clinical cure criteria. Xiaochen will enter our long-term standardized follow-up program alongside elder brother Xiaojia for regular developmental monitoring through puberty, marking the full completion of clinical care.

Core Clinical Principles: Building a One-Stop Treatment Hub for Hypospadias Repair

The two siblings’ successful recoveries illustrate five core principles adhered to by Amcare’s pediatric surgery team for comprehensive hypospadias management:

1. Individualized treatment is the core of hypospadias care

Topical hormone medication prior to surgery (as applied on Xiaochen) is not universally applicable across all patients. Routine hormone prescription for every underdeveloped penis is an outdated rigid practice; for severe hypospadias with profound chordee, hormone therapy may enlarge penile shaft yet worsen curvature and complicate subsequent reconstruction.

No universal treatment formula fits all cases. For patients with acceptable penile straightening like Xiaochen, hormone priming before surgery is rational; for severe cases with severe ventral bending, staged surgery is indicated: Stage 1 to correct penile curvature and harvest supplementary urethroplasty graft material, followed by hormone-assisted penile development and definitive urethroplasty once anatomical conditions permit.

2. Minimum three alternative surgical protocols preoperatively per case

Hypospadias repair ranks among the most technically demanding pediatric urologic operations globally, with over 300 documented surgical techniques recognized in literature, reflecting its inherent complexity. At Amcare, surgeons formulate no fewer than three backup surgical plans before every procedure. As Director Xu noted, definitive anatomical status of urethra and corpus spongiosum is only visible intraoperatively; surgical success hinges on flexible intra-op adjustment against unforeseen findings.

3. Post-op follow-up continues through puberty, not limited to wound healing

Many clinicians and families mistakenly consider treatment complete once wounds heal and urination normalizes. Yet long-term surveillance up to puberty is mandatory: underdeveloped urethral spongiosum may trigger recurrent penile bending or urethral stricture during adolescent rapid physical growth, compromising adult sexual function and fertility. All post-op children at Amcare receive periodic developmental assessment until full pubertal maturation.

4. Long-term follow-up prioritizes screening for acquired undescended testis

Longitudinal surveillance enables early identification of latent complications such as acquired undescended testis (acquired cryptorchidism): testicles originally located in the scrotum ascend gradually to inguinal or higher abdominal regions as the child grows. While sporadically reported internationally, only two domestic case reports existed before our team identified eight such patients via prolonged post-hypospadias follow-up; our findings were published in the Chinese Journal of Pediatric Surgery in 2023 and 2024 as a review and 8-case clinical analysis respectively, advancing domestic clinical understanding.

Clinical data proves severe hypospadias patients (especially those with retractile testis) face drastically elevated acquired cryptorchidism risk. Undescended testis correlates strongly with testicular malignancy and impaired fertility, requiring timely orchiopexy upon detection. Regular long-term follow-up facilitates early intervention before irreversible testicular damage develops.

5. Establishing a full-cycle one-stop hypospadias treatment center

Our center accepts all complex revision cases of failed prior hypospadias repair, despite heightened technical difficulty from post-surgical scarring, distorted anatomical planes and depleted graft tissue. Our full-spectrum service covers pre-conception genetic counseling, multidisciplinary prenatal consultation upon abnormal ultrasound findings, immediate neonatal surgical evaluation, personalized therapeutic planning, precise operative reconstruction and lifelong developmental follow-up into adulthood, fulfilling our mission as a comprehensive terminal-care hub for hypospadias patients nationwide.