Hypospadias and Medical Negligence in Chicago
Hypospadias is a congenital condition in which the urethral opening is located somewhere on the underside of the penis instead of at its usual position at the tip. The urethra is the passage that carries urine from the bladder to the outside of the body.
The location of the opening can range from an area just below the head of the penis to the shaft, the junction of the penis and scrotum, or, in a severe case, an area within or behind the scrotum. Some children also have downward curvature of the penis, an incompletely formed foreskin, or an undescended testicle.
Most cases of hypospadias are not caused by medical malpractice. The cause cannot be identified in many children. Genetic, hormonal, developmental, maternal, and environmental influences may affect risk, but the diagnosis alone does not demonstrate that a physician, hospital, pharmaceutical company, or another party acted negligently.
A legal issue may exist in limited circumstances involving an avoidable circumcision injury, failure to recognize significant associated findings, negligent corrective surgery, or failure to identify and treat a postoperative complication.
Free legal evaluation: If your concern involves a particular medical error rather than the congenital condition by itself, contact Sexner Injury Lawyers LLC or call (312) 243-9922.
How Hypospadias Develops
During early fetal development, hormones help direct the formation of the urethra, penis, and foreskin. Hypospadias occurs when the tissues that ordinarily form the urethral channel do not join completely.
The position of the opening and the presence of other anatomical differences determine the severity of the condition. Hypospadias is generally identified in male newborns because it affects the formation of the penis.
General medical information is available from the Centers for Disease Control and Prevention.
Types of Hypospadias
Healthcare providers commonly describe hypospadias according to the location of the urethral opening:
- Subcoronal or distal hypospadias: The opening is close to the head of the penis. This is generally a less severe and more common form.
- Midshaft hypospadias: The opening is situated somewhere along the underside of the penile shaft.
- Penoscrotal or proximal hypospadias: The opening is located near the point where the penis and scrotum meet. More extensive reconstruction may be required.
Location alone does not determine the entire treatment plan. The pediatric urologist also evaluates penile curvature, the quality of the surrounding tissue, the foreskin, the urinary stream, and whether another urinary or genital difference is present.
Possible Signs and Associated Findings
Hypospadias is usually identified during the newborn examination. Possible findings include:
- A urethral opening below the normal location
- A urinary stream that sprays downward or is difficult to direct
- Downward curvature of the penis, sometimes called chordee
- A hooded appearance because the foreskin has not formed completely underneath the penis
- One or both testicles not fully descended into the scrotum
- Other differences involving the urinary tract or genital development in some children
When severe hypospadias occurs together with an undescended testicle or genital anatomy that is not clearly defined, the child may need additional genetic, hormonal, or anatomical evaluation.
Do Not Circumcise Before a Urology Evaluation
A newborn with suspected hypospadias generally should not be circumcised before being evaluated by a pediatric urologist. The foreskin may provide tissue needed during reconstructive surgery.
Parents who are told that their child may have hypospadias should make sure that the delivering hospital, pediatrician, and anyone planning circumcision are aware of the suspected condition.
An unintended circumcision does not automatically constitute malpractice. A legal and medical review would need to determine whether the condition should reasonably have been recognized before the procedure, whether useful tissue was unnecessarily removed, and whether the circumcision complicated later treatment or caused another injury.
Treatment of Hypospadias
Treatment depends on the opening’s location, the degree of curvature, the child’s urinary function, and the complexity of the anatomy. Most children undergo corrective surgery during infancy, often between approximately 6 and 18 months of age. The precise timing is determined by the pediatric urologist.
The goals of surgery may include:
- Moving the urethral opening closer to the tip of the penis
- Creating a urinary channel that functions properly
- Correcting significant penile curvature
- Reconstructing the surrounding skin
- Supporting future urinary and sexual function
A mild case without meaningful curvature or urinary difficulty may not always require surgery. The family and pediatric urologist should discuss the potential benefits, risks, and long-term considerations.
One Operation or Staged Repair
Many distal cases can be repaired during one operation. A more severe form may require two or more procedures because the surgeon must straighten the penis, reconstruct a longer section of urethra, and work with limited available tissue.
A catheter may remain temporarily after surgery so that urine can drain while the reconstructed area heals. Follow-up is important because certain complications may not become apparent immediately.
Possible Surgical Complications
Hypospadias surgery often produces good functional results, but complications can occur even when appropriate care is provided. Possible problems include:
- A urethrocutaneous fistula, which allows urine to leak through an unintended opening
- Narrowing of the reconstructed urethra or its opening
- Breakdown or separation of repaired tissue
- Persistent or recurrent penile curvature
- Abnormal spraying or difficulty passing urine
- Infection, bleeding, or a hematoma
- Scarring or concerns about appearance
- The need for another operation
The occurrence of a known complication does not, by itself, establish negligent surgery.
Possible Causes and Risk Factors
The cause is unknown in many individual cases. Research has identified associations involving genetics, family history, maternal health, reproductive treatment, hormonal influences, and environmental exposures.
Factors reported in medical research include:
- A family history of hypospadias
- Certain genetic influences affecting urethral development
- Maternal age or weight-related factors
- Use of assisted reproductive technology
- Exposure to certain hormones around the beginning of pregnancy
A reported association is not proof of causation. It does not show that the condition was preventable or that a healthcare provider was negligent.
Medication Claims Require Individual Medical Evidence
The former version of this page named anticonvulsants, SSRI antidepressants, Clomid, and Zofran as drugs connected with hypospadias. Those broad assertions have been removed because they do not establish that any one medication caused a particular child’s condition.
A medication-related legal review would need to consider:
- The exact drug and dosage
- The reason it was prescribed
- The timing of exposure during fetal development
- The risks of leaving the maternal condition untreated
- Reasonably available alternatives
- The scientific knowledge available at the time
- The information and monitoring provided to the patient
- Whether reliable medical evidence supports individual causation
A pregnant patient should not discontinue prescribed medication without first speaking with an appropriate healthcare provider. More information about preventable prescribing and dispensing mistakes is available on our medication and prescription error page.
When Could Medical Negligence Be Relevant?
The existence of hypospadias ordinarily does not support a malpractice claim. A potential case generally requires a separate medical mistake that caused additional preventable harm.
Failure to Recognize the Condition Before Circumcision
A review may be appropriate when a provider performed or approved circumcision despite visible findings that should have prompted a pediatric urology consultation. Relevant questions include whether:
- The abnormal urethral opening was apparent during the newborn examination
- The foreskin had the characteristic incomplete appearance
- The condition was documented but not communicated
- The circumcision removed tissue needed for reconstruction
- The procedure caused another injury or made later surgery more difficult
Failure to Evaluate Associated Findings
Additional review may be appropriate when severe hypospadias, an undescended testicle, abnormal genital anatomy, urinary problems, or another significant finding was not investigated or referred to an appropriate specialist.
A delayed diagnosis does not automatically establish negligence. A possible diagnostic-error claim generally requires evidence that the delay fell below the accepted standard of care and caused additional harm.
Negligent Surgery or Follow-Up
A legal issue may exist when preventable injury results from:
- Inadequate surgical planning
- Use of an inappropriate technique under the circumstances
- Damage to the urethra, penis, blood supply, or surrounding tissue
- A preventable surgical error
- An anesthesia, medication, or monitoring mistake
- Failure to recognize a fistula, obstruction, infection, bleeding, impaired circulation, or wound breakdown
- Failure to provide appropriate follow-up or referral after complications developed
Records Used to Evaluate a Potential Case
A medical and legal review may require:
- Delivery and newborn examination records
- Circumcision consent and procedure records
- Pediatric and pediatric-urology examinations
- Photographs or diagrams documenting the anatomy
- Genetic, hormonal, or imaging studies when performed
- Operative and anesthesia reports
- Catheter, nursing, and wound-care records
- Postoperative and emergency-department records
- Records of later corrective operations
Medical experts may need to separate the child’s congenital anatomy from any additional injury allegedly caused by circumcision, surgery, or inadequate follow-up.
Contact Sexner Injury Lawyers LLC
Most children born with hypospadias do not have a medical malpractice claim. A legal review may be appropriate when there is a specific concern involving circumcision despite recognizable hypospadias, failure to investigate associated findings, negligent corrective surgery, or failure to treat a postoperative complication.
Contact Sexner Injury Lawyers LLC or call (312) 243-9922 for a free and confidential evaluation. We will explain honestly whether the circumstances appear to justify further investigation.
