Blog

Hypospadias and Circumcision in Babies: My Experience and Approach

How I coordinate circumcision with a consultant urologist during hypospadias repair, including the considerations involved in one-stage and staged surgery.

Written by Dr Martin Harris BPharm Hons, MB BS, LRCP MRCS, FRCGP, RCPathMe

My Experience Managing Hypospadias and Circumcision

Over many years, I have developed a longstanding working relationship with a consultant urologist who performs reconstructive surgery for hypospadias. Together, we coordinate the treatment of boys who require correction of this congenital penile abnormality and whose parents also wish them to be circumcised.

My role is to perform the circumcision, while my consultant urology colleague undertakes the reconstructive repair of the hypospadias. We coordinate the procedures so that, where clinically appropriate, both can be performed during the same operative session under one anaesthetic.

This established collaboration allows us to plan the circumcision around the requirements of the reconstructive surgery, taking account of the position of the urinary opening, the degree of penile curvature and the tissues needed for the repair.

In many of the boys we treat, the anatomy is suitable for a one-stage hypospadias repair, with circumcision performed during the same operation. Where the abnormality is more pronounced and a staged reconstruction is considered necessary, the timing and extent of circumcision must be planned particularly carefully.

One of the most important principles in treating hypospadias is that the foreskin must be preserved until the reconstructive surgeon has assessed whether it is needed for the operation. Removing it prematurely may limit the surgical options available.

Our approach is therefore based on coordination and careful planning. The consultant urologist determines the reconstructive requirements, and I undertake circumcision in accordance with the agreed operative plan.

For parents, this means that circumcision can be considered alongside the treatment of hypospadias rather than automatically being arranged as a separate procedure.

My experience has reinforced the importance of treating each child individually and ensuring that circumcision complements the reconstructive plan rather than compromising it.

What Is Hypospadias?

Hypospadias is a congenital condition affecting the development of the penis and urethra in boys. It is present at birth and occurs when the opening through which urine passes, known as the urethral meatus, is located on the underside of the penis rather than at the tip.

Hypospadias affects approximately 0.5% of boys in some population estimates, although reported frequencies vary between populations and studies.

The precise cause is not fully understood. Genetic, hormonal and developmental factors are thought to contribute to the condition.

The severity varies considerably. In some boys, the opening is only slightly displaced from the tip of the penis. In others, it is located further down the penile shaft or close to the junction between the penis and scrotum.

The condition may also be associated with downward curvature of the penis, an incomplete foreskin or other congenital abnormalities.

Hypospadias is sometimes identified during the newborn examination. In other cases, the abnormality may become apparent when parents or healthcare professionals notice an unusual appearance of the penis or a urinary stream that does not pass forwards normally.

An accurate assessment is important because the position of the opening alone does not always determine the complexity of the repair.

What Are the Signs of Hypospadias?

The appearance of the penis is often the first indication of hypospadias.

Parents may notice that the urinary opening is not situated at the tip, or that the foreskin appears to form a hood over the upper surface of the glans rather than a complete covering around it.

Possible features include:

An opening on the underside of the penis.
A hooded or incomplete foreskin.
Downward curvature of the penis.
A urinary stream that is directed downwards or sprays rather than passing straight forwards.

The degree of abnormality varies. Some boys have a relatively minor displacement of the opening, while others have more extensive anatomical changes.

Boys with hypospadias can generally pass urine through the abnormal opening. However, the direction of the urinary stream and the presence of any associated narrowing or other abnormalities need to be considered.

Difficulty passing urine or an inability to urinate requires prompt medical assessment.

A baby with suspected hypospadias should be examined by an appropriately qualified clinician before circumcision is arranged.

Are There Different Types of Hypospadias?

Hypospadias is commonly described according to the position of the urethral opening.

Distal hypospadias

The opening is located near the tip of the penis, often on the glans or just below it. These cases are generally less complex, although the degree of curvature and the condition of the surrounding tissues remain important.

Midshaft hypospadias

The opening is situated further down the underside of the penile shaft. The reconstruction may be more involved, depending on the anatomy and any associated curvature.

Proximal hypospadias

The opening is located towards the base of the penis or near the penoscrotal junction. These cases are often more complex and may require more extensive reconstruction or a staged surgical approach.

These categories provide a general description rather than a complete assessment of severity. Two boys with openings in similar positions may require different operations because of differences in penile curvature, the urethral plate and the available tissue.

This is why the reconstructive surgeon’s assessment is essential before deciding how circumcision should be incorporated into treatment.

Why Is the Foreskin Important in Hypospadias?

The foreskin is particularly important when considering circumcision in a baby with hypospadias.

During routine circumcision, the foreskin is removed to expose the glans. However, in hypospadias, foreskin tissue may be required for reconstructive surgery.

Depending on the individual anatomy and the technique selected, the surgeon may use preputial tissue to help reconstruct the urethra or provide suitable skin coverage.

The operation may also involve correcting penile curvature and reconstructing the tissues around the urinary opening. The availability of healthy tissue can influence the surgical options.

If the foreskin is removed before the reconstructive surgeon has assessed the child, tissue that might otherwise have been useful may no longer be available.

For this reason, routine circumcision should not be performed before suspected hypospadias has been assessed and a treatment plan established.

This does not mean that circumcision is always incompatible with hypospadias repair. In appropriately selected cases, circumcision can be incorporated into the reconstructive operation.

The important distinction is between performing circumcision without first assessing the abnormality and performing it as a planned component of specialist treatment.

What Is the Aim of Hypospadias Repair?

Hypospadias repair is reconstructive surgery intended to improve the anatomy and function of the penis.

The objectives depend on the severity of the condition and the individual child’s anatomy.

The principal aims may include:

Correcting penile curvature

Some boys have downward curvature, sometimes called chordee. Where clinically significant, this may need to be corrected as part of the operation.

Reconstructing the urethra

The surgeon may reconstruct the urinary channel so that the opening can be positioned towards the tip of the penis. The appropriate technique depends on the original anatomy and the tissue available.

Creating an appropriately positioned urinary opening

The aim is to provide a suitable opening that allows urine to pass effectively. The precise result depends on the complexity of the original abnormality and the reconstruction undertaken.

Providing suitable penile skin coverage

Following reconstruction, the skin must be arranged to cover the penis appropriately. The foreskin may be useful for this purpose in some cases.

Achieving a satisfactory functional and cosmetic result

The overall aim is to improve urinary function, correct significant curvature and achieve an acceptable appearance while minimising complications.

It is important for parents to understand that hypospadias repair is a specialist reconstructive operation. Circumcision alone cannot correct the underlying abnormality.

My Approach to Coordinating Hypospadias Repair and Circumcision

My longstanding collaboration with a consultant urologist allows us to coordinate reconstructive surgery and circumcision as part of one planned treatment pathway.

The consultant urologist assesses the hypospadias and undertakes the reconstruction. I perform the circumcision when it is appropriate within the agreed operative plan.

Before proceeding, the reconstructive requirements must be understood. In particular, we need to establish whether the foreskin is required for the urethral repair or for adequate skin coverage.

This is a crucial consideration because the priority is to achieve the best possible reconstructive result.

Where the anatomy permits a one-stage repair and the foreskin is not required for reconstruction, circumcision can generally be incorporated into the same operative session.

For parents, this offers the practical advantage of coordinating both procedures under one anaesthetic, rather than arranging circumcision as a separate operation at another time.

However, the suitability of this approach depends on the individual child’s anatomy and the surgical plan. The decision is made in collaboration with the reconstructive surgeon rather than on the basis of the parents’ request for circumcision alone.

Our established working relationship enables us to consider these issues together and plan the procedures accordingly.

One-Stage Hypospadias Repair and Circumcision

In many of the boys we treat, the degree of hypospadias allows the reconstructive surgeon to undertake the repair in one operation.

During the procedure, the consultant urologist corrects the anatomical abnormality using the technique considered appropriate for the child. This may involve reconstruction of the urethra, correction of penile curvature where necessary and appropriate arrangement of the surrounding tissues.

I perform the circumcision during the same operative session when this is compatible with the reconstruction.

The advantage of coordinating the procedures is that circumcision can be planned around the reconstructive work, with appropriate attention to the tissue required for the repair and the final skin coverage.

It is important to emphasise that not every boy with hypospadias is suitable for a one-stage repair. The position of the urinary opening, the degree of curvature and the quality of the available tissue all influence the choice of operation.

The consultant urologist determines the appropriate reconstructive technique and whether the planned procedure can be completed in one stage.

Where a one-stage repair is suitable, coordinating circumcision during the same operative session provides a practical and carefully planned approach to both procedures.

More Severe Hypospadias and Staged Repair

Where hypospadias is more extensive, the reconstructive surgeon may recommend a staged approach.

This is particularly relevant in some boys with a more proximal opening, significant penile curvature or anatomy that makes a one-stage reconstruction less suitable.

A staged repair allows the reconstruction to be undertaken in separate operations. The precise steps depend on the individual anatomy and the technique selected by the consultant urologist.

In the cases we manage, circumcision may be performed during the first operative session when this is compatible with the reconstructive plan.

However, this decision requires particular care. In more severe hypospadias, foreskin tissue may be needed for a later stage of reconstruction. If it is required, it must be preserved.

For this reason, circumcision at the first stage is not automatic. It is undertaken only when the consultant urologist has determined that removing the foreskin is compatible with the planned reconstruction and will not compromise the tissue required for subsequent surgery.

This distinction is important for parents. A staged repair does not necessarily mean that circumcision must be delayed until all reconstructive procedures are complete, but neither does it mean that circumcision should routinely be performed at the first operation.

The timing is determined by the reconstructive requirements of the individual child.

Why Circumcision Should Not Be Performed Before Specialist Assessment

Parents sometimes contact me to arrange circumcision before they are aware that their baby may have hypospadias.

If the urinary opening is unusually positioned or the foreskin appears incomplete, the priority is to establish whether a congenital penile abnormality is present.

Proceeding with routine circumcision without appropriate assessment may remove tissue that could be useful during reconstruction.

This is why the European Association of Urology advises against simple circumcision when hypospadias is present.

The recommendation does not mean that a child with hypospadias cannot subsequently be circumcised. Rather, circumcision needs to be considered in the context of the reconstructive plan.

My advice to parents is to ensure that the child has been assessed by an appropriate specialist before circumcision is arranged.

Where hypospadias repair is required and circumcision is also desired, coordination between the reconstructive surgeon and the clinician performing circumcision allows both matters to be considered together.

Are There Risks Associated with Hypospadias Repair?

Hypospadias repair is a specialist operation, and parents should understand that complications can occur.

The risks vary according to the severity of the condition, the surgical technique, the child’s anatomy and whether the procedure is a primary or repeat repair.

Possible complications include:

Urethrocutaneous fistula: an abnormal channel between the reconstructed urethra and the skin.
Meatal stenosis: narrowing of the urinary opening.
Urethral stricture: narrowing within the reconstructed urinary channel.
Wound-healing problems: including separation of the wound or glans.
Persistent or recurrent curvature: where the penis remains curved or curvature develops again.
Further surgery: if a complication occurs or the intended functional or anatomical result is not achieved.

These complications do not occur in every child, and many boys have satisfactory outcomes following repair. However, more complex cases may carry greater risks and may require more than one operation.

The consultant urologist should discuss the anticipated benefits, relevant risks, proposed technique and follow-up arrangements with the parents before surgery.

Circumcision must be coordinated with these considerations rather than treated as an independent procedure.

Why Follow-up Matters After Hypospadias Repair

Follow-up is an important part of care after hypospadias surgery.

The specialist team will assess healing, urinary function and the appearance of the reconstructed penis. Depending on the original abnormality and the operation performed, further assessment may be needed to identify narrowing of the urethra, fistula formation, recurrent curvature or other complications.

Some problems may become apparent only after a period of time. Longer-term follow-up is therefore important, particularly in boys who have undergone more complex reconstruction.

Parents should follow the treating team’s instructions concerning wound care, dressings, urinary drainage where used and postoperative appointments.

They should seek prompt medical advice if their child develops difficulty passing urine, significant bleeding, increasing swelling, fever or other concerning symptoms following surgery.

The timing and duration of follow-up depend on the child’s individual circumstances and the recommendations of the treating team.

Frequently Asked Questions

Can a baby with hypospadias be circumcised?

Yes. Circumcision can be performed in selected boys with hypospadias, but routine circumcision should not take place before specialist assessment. The foreskin may be needed for reconstruction, so the timing must be agreed with the reconstructive surgeon.

Can circumcision and hypospadias repair be performed during the same operation?

Yes. In appropriately selected cases, circumcision can be coordinated with hypospadias repair during the same operative session under one anaesthetic. This depends on the anatomy, the reconstructive technique and whether the foreskin is needed for surgery.

Who performs the hypospadias repair and circumcision?

In my established practice, I work closely with a consultant urologist who performs the reconstructive repair. I perform the circumcision as part of the same operative session when clinically appropriate and when the agreed surgical plan permits it.

Why should circumcision not be performed before hypospadias repair?

The foreskin may contain tissue required for reconstructing the urethra or providing appropriate skin coverage. Removing it prematurely may limit the reconstructive surgeon’s options. Specialist assessment should therefore take place before circumcision.

Can all cases of hypospadias be repaired in one operation?

No. Many cases can be managed with a one-stage repair, but more complex abnormalities may require staged reconstruction. The decision depends on the position of the urethral opening, penile curvature, the urethral plate and the available tissue.

If my baby needs a two-stage repair, can circumcision be performed at the first operation?

In selected cases, yes. Circumcision may be performed during the first operative session if the consultant urologist determines that the foreskin is not required for subsequent reconstruction. If the tissue is needed for a later stage, it must be preserved.

Does circumcision correct hypospadias?

No. Circumcision does not correct the position of the urethral opening or any associated penile curvature. These abnormalities require specialist reconstructive treatment. Circumcision is a separate procedure that may be incorporated into the operative plan where appropriate.

Is hypospadias associated with undescended testicles?

Yes. Undescended testicles can occur alongside hypospadias. When hypospadias is severe, particularly when both testicles are undescended, additional specialist assessment may be necessary to investigate associated conditions.

Will my baby need further surgery after hypospadias repair?

Not every child requires further surgery. However, complications can occur, and some boys with more complex abnormalities need additional procedures. Follow-up with the treating specialist is important to assess healing and urinary function.

What should I do if I suspect my baby has hypospadias before circumcision?

Contact the clinician arranging the circumcision and explain your concerns. Routine circumcision should be postponed until the baby has been assessed and an appropriate treatment plan established.

My Final Message to Parents

A diagnosis of hypospadias can raise understandable concerns for parents, particularly when they are also considering circumcision for their baby.

The important point is that the two procedures must be considered together. The foreskin may be needed for reconstructive surgery, and removing it before specialist assessment can limit the options available to the surgeon.

My longstanding collaboration with a consultant urologist enables us to coordinate hypospadias repair and circumcision within one planned treatment pathway.

In many cases, the repair and circumcision can be completed during the same operative session. In more complex cases, staged reconstruction may be required, and the timing of circumcision depends on whether the foreskin is needed for subsequent surgery.

The decision must always reflect the individual child’s anatomy and the reconstructive surgeon’s assessment.

For me, the central principles are simple:

Assess the hypospadias. Preserve tissue needed for reconstruction. Coordinate the repair and circumcision. Plan follow-up carefully.

Circumcision can form part of the treatment pathway for selected boys with hypospadias, but it should always be planned in a way that supports, rather than compromises, the reconstructive outcome.

Medical Information Disclaimer

This article describes my approach to coordinating circumcision with hypospadias repair. It is provided for general educational purposes and is not a substitute for individual medical advice, clinical assessment or treatment by an appropriately qualified healthcare professional.

Hypospadias is a congenital condition that requires individual assessment. Parents should seek advice from an appropriately experienced specialist before arranging circumcision when hypospadias is present or suspected.

Routine circumcision should be deferred until the reconstructive requirements have been assessed. The suitability and timing of circumcision depend on the child’s anatomy and the agreed surgical plan.

Last medically reviewed: October 2026 — confirm this date following clinical review before publication.

Written by: Dr Martin Harris BPharm Hons, MB BS, LRCP MRCS, FRCGP, RCPathMe