Ectopic urethral opening The symptoms of hypospadias are that the urethral opening is not located in its normal position, and in the center of the distal glans, but on the ventral side of the penis, in the pathway from the proximal end of the normal urethral opening to the perineum. The closer the urethral opening is to the scrotum or perineum, the more severe the hypospadias is. Hypospadias The penis is curved ventrally. Only 35% of cases of hypospadias are associated with significant penile recurvature, and most of them are mildly recurved. Hypospadias is classified as mild (35°) according to the angle between the head of the penis and the longitudinal axis of the penis body. The latter two have difficulty in sexual intercourse in adulthood. The main causes of penile recurvature are hyperplasia of the fibrous tissue of the urethral plate, lack of layers of subcutaneous tissue on the ventral side of the urethra of the penile body, and asymmetry of the dorsal and ventral sides of the penile corpus cavernosum. Abnormal distribution of the foreskin The foreskin ventral to the head of the penis fails to fuse in the midline, so there is a V-shaped defect, the foreskin tether is absent, and all of the foreskin is transferred to the dorsal side of the head of the penis in a cap-like accumulation. Other associated anomalies Other associated anomalies include cryptorchidism (7% to 9%), inguinal hernia (approximately 12%), and syringomyelia (9% to 16%). The incidence of inguinal hernia is similar in patients with anterior, middle and posterior hypospadias, but cryptorchidism is more common in patients with posterior hypospadias. Male infants with both hypospadias and cryptorchidism should also be alerted to the need to evaluate for the possibility of hermaphroditism when the external genitalia are evident in time. Prostatic capsules occur in severe hypospadias and may be a remnant of incomplete degeneration of the paramedian duct or incomplete masculinization of the urogenital sinus. Some patients may have combined scrotal transposition, penile torsion, micropenis and duplicated urethra, and in rare patients, anorectal malformations.