Hypospadias is a congenital anomaly that typically occurs in males. It typically presents with a proximal displacement of the urethral opening, penile curvature, and a ventrally deficient hooded foreskin [8]. Hypospadias is classified based on the anatomical location of the displaced urethral orifice into distal-anterior (located on the glans or distal shaft and the most common type), intermediate-middle (penile), and proximal-posterior (penoscrotal, scrotal, perineal) [9]. Distal-anterior hypospadias is the most prevalent type among these classifications [9]. Hypospadias is diagnosed clinically. In patients who present with hypospadias, it is important to rule out sexual differentiation causes by performing an endocrinological evaluation; nonetheless, it should be pointed out that endocrinological evaluation is not mandatory in distal hypospadias. These patients typically present with concomitant ambiguous genitalia, cryptorchidism, male subfertility, and testicular cancer [10].

Recent studies suggest that hypospadias, along with cryptorchidism, poor semen quality, and testicular germ cell cancer, may be part of a broader condition known as testicular dysgenesis syndrome (TDS) [11]. TDS is thought to arise from disrupted testicular development due to genetic, environmental, and lifestyle factors, including exposure to endocrine-disrupting chemicals (EDCs) and intrauterine growth disorders [11]. The syndrome highlights the impact of both prenatal and postnatal factors on male reproductive health. Research underscores the importance of understanding these complex interactions to address the increasing incidence of these reproductive disorders, particularly in highly industrialized regions [11]. Prioritizing research in reproductive physiology and pathophysiology is crucial to developing effective prevention and treatment strategies for TDS [11].

Annually, the prevalence of hypospadias internationally is 20.9 per 10,000 births, with the majority of cases in males compared to females. Patients with a positive family history of hypospadias are more likely to express it if the malformation affected first-, second-, or third-degree relatives [12]. The two most common syndromes linked with hypospadias include Wilms’ tumor, aniridia, genitourinary malformations, range of developmental delays (WAGR), and the Denys-Drash syndrome. Incidence is shown to have increased in children with small gestational age and monochorionic twins. Other prenatal factors that should be monitored to prevent hypospadias include maternal hypertension, oligohydramnios, and premature delivery [13].

Hypospadias treatment varies based on severity and symptoms. The current guidelines for hypospadia repair are somewhere between 6 and 18 months of age. Surgery is usually the treatment of choice unless it is a very mild case. An essential step in management is determining if significant curvature persists after ventral dissection. It was determined that dorsal plication was applicable only in minor degrees of curvature [14]. One important benefit to performing surgery before 18 months of age is the lack of genital awareness in the patient. Studies have shown that adolescents who do not recall the surgery are more likely to have a positive body image throughout life [15]. Post-surgery, most boys are seen twice in the first three months and are typically monitored into puberty. Once toilet trained, he is asked to urinate in the office to evaluate for a strong urinary stream.

Complications that can arise from the surgical repair include urethral fistulas, meatal stenosis (which would require a meatotomy), a urethral diverticulum, and frequent urinary tract infections (UTIs) [16]. In proximal and complex hypospadias repair, an ultrasound or an endoscopy of the urethra during the repair is suggested to rule out the presence of urethral anomalies. If these anomalies go undiscovered, they predispose the patient to more frequent UTIs [17]. If surgery is deferred, then the patient is most likely to experience sexual dysfunction and difficulty urinating while standing [18].

Our case centers on a neonate diagnosed with hypospadias, prompting the need for further evaluation by a urologist. This evaluation aims to identify the most effective management approach, ultimately aiming to prevent long-term complications. Looking ahead, we would like to leverage advancing technology to help us administer proper treatment with minimal post-surgical complications in the future.