Congenital anomalies of the urethra – male and female
In hypospadias, the male urethra along with the adjacent penis can be afflicted by a failure of development. In this situation, the penis is not fully formed and the urethra is neither fully developed, nor normally positioned, on its underside. The defect in the penis causes initial cosmetic and, if untreated, subsequent sexual disadvantage through erectile dysfunction. The defect in the urethra relates to the position of its external meatus. In the normal penis, this is on the tip of the glans penis. In hypospadias, depending on the degree of severity, the opening may be either at the base of the glans penis (coronal hypospadias), anywhere along the shaft of the penis (penile hypospadias), or within the perineum (perineal hypospadias). Severe cases of hypospadias may present problems of ambiguous genitalia and, hence, difficulty in gender assignment. In purely urological terms, hypospadias presents problems by way of a spraying urinary stream, for the coronal and penile variants, and the need to sit down for voiding in the perineal type. In other regards, the urinary tract is not greatly disadvantaged by hypospadias. On the other hand, the appearance and subsequent erectile dysfunction can cause significant psychosexual stress in adolescence.