Question Title: Chordee or hypospadias?

When My son was born the OB could not perform his circumcision because my son had an allergic reaction to the EMLA cream used to numb the penis. We took him to a ped urologist at 6 wks to have it done and was told by that Dr. that he had hypospadias and showed us what looked like to holes at the top of his penis. The holes are side by side he called it very mild hypospadias (not underneath or far apart like most hypospadias conditions). We were told to have it corrected when he was 6 months and they would do the circumcision then also. We changed health insurance and went to a diffrent ped urologist, he told us that my son does not have hypospadias at all that he has chordee WITHOUT hypospadias. I explained to the second Dr. that I can clearly see two holes at the top of his penis I thought that was called hypospadias. He said that he did not see two holes and that it might be a fold or crease in the skin due to his chordee. He also showed us how the foreskin was longer on top and shorter on the bottom of the penis, which he said is a common condition of chordee. I feel he has both but this doctor was positive I was wrong. How could two doctors come up with two diffrent diagnosis? Should I get a third opinion and if so how will I know who is right?

Dear Juliana,
Hypospadias is a condition of varying severity in which the opening of the urethra ( the urethral meatus) is not at the tip of the penis, where it usually is, but instead is variably located along the head and shaft below, on the bottom of the penis. Not infrequently, chordee is also present along with hypospadias. This is a band of fibrous tissue which connects the tip of the penis to the frenulum in the bottom, thereby, causing a bowing/ bending of the penile tip which is a characteristic appearance of the chordee. The two conditions may also be present independently.

As far as two openings at the tip of the penis is a separate entity referred to as urethral duplication. The two openings may be one on top of the other, or side by side, the former being the more common one. There are different types of urethral duplication in terms of their internal anatomy varing from both openings being functional and connected to the bladder, to one being only a “blind pit” or just an impression of an opening. In any case this requires close and careful examination. Given your history of encounters as you described above, you may seek another urologist’s opinion to settle the controversy, since without an examination, I could not make a definitive statement.

This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its urban campuses by calling (1 800 653 6568).

Sincerely;
HFHS-M.D. BE
* Keyword:hypospadias/chordee