Hypospadias

Dorsal hooded foreskin

chordee

abnormal ventral meatus

scrotum

Hypospadias is a complex of an abnormal ventral meatus, chordee, and a dorsal hooded foreskin. Usually isolated, it can be part of the DSD spectrum.

Incidence: one in 300 live-births (but wide variation from 1 in 110 to 1 in 1,250)

Rising incidence Associating with inguinal hernia and hydro

cele (~10%), undescended testes (~8%)

EmbryologyThe development of male urethra takes plac

e between the 8th and the 15th week of gestation under the influence of testosterone.

EtiologyMultifactorial involving genetic, endocrine, a

nd environmental factors.

Genetic Factors

Inheritance is unknown.The following facts:

Monozygotic twins – eightfold increase in the incidence of hypospadias

family history – 8% of fathers and 14% of brothers

Endocrine Factors

Deficient androgenic stimulation Increased maternal progesterone exposure

Environmental Factors ↑Incidence of hypospadias and one hypoth

esis suggests that there is increased maternal exposure to estrogenic substances (contained in pesticides, milk, plastic linings of metal cans, and pharmaceuticals).

Clinical Features

Classification Distal (glanular, coronal, and subcoronal) (5

0%) Middle (distal penile, midshaft, and proximal

penile) (30%) Proximal (penoscrotal, scrotal, and perinea

l) (20%)

Surgery

Principles The goal of surgery is to create a

cosmetically acceptable penis, which allows normal voiding with a forward stream and normal vaginal penetration.

Preoperative completing the repair of hypospadias before 18

months of age (minimizes psychological impact of genital surgery).

Hormone manipulation correction of chordee Urethroplasty Meatoplasty and glanuloplasty Skin coverage

Postoperative

Early complications

bleeding, hematoma, infection, and breakdown of repair.

Long-Term Outcome persistent chordee, meatal stenosis, urethrocu

taneous fistula, urethral stricture, and urethral diverticulum. The incidence is highly variable though.

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