The penis: hypospadias, epispadias, phimosis and balanoposthitis
- Lesion
The urethral opening may be misplaced, the foreskin too tight, and poor hygiene lets infection inflame the glans and prepuce.
What it is
Hypospadias is the commonest congenital anomaly of the penis: the urethra opens on the ventral surface because the urethral folds fail to fuse; it often comes with undescended testes and inguinal hernia. Epispadias opens dorsally and accompanies bladder exstrophy. Phimosis is a foreskin too tight to retract, congenital or after repeated inflammation; forcing it back can trap the glans (paraphimosis). Balanoposthitis is infection of the glans and prepuce by Candida, anaerobes, Gardnerella or pyogenic bacteria. Sexually transmitted infections (syphilis, herpes, chancroid, granuloma inguinale) produce ulcers.
Structure
- Balanoposthitis: nonspecific acute and chronic inflammation of the glans and inner foreskin.
- Chronic inflammation leads to scarring of the prepuce and phimosis.
- Lichen sclerosus (balanitis xerotica obliterans) is a sclerosing lesion that causes phimosis and is linked to HPV-independent carcinoma.
Clinical notes
- Hypospadias with bilateral undescended testes requires evaluation for disorders of sex development.
- Good hygiene and treatment of phimosis lower the risk of infection and cancer.
Test yourself
Think of the answer, then tap the question to see it.
On which surface does the urethra open in hypospadias?
On the ventral (under) surface of the penis.
Which anomaly accompanies epispadias?
Bladder exstrophy.
Why does phimosis matter beyond discomfort?
It favours repeated balanoposthitis and is a risk factor for penile squamous cell carcinoma.
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Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Hypospadias Urogenital Reconstruction (StatPearls (NCBI Bookshelf), 2024); Phimosis (StatPearls (NCBI Bookshelf), 2024).
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Representative model, for educational purposes only.