Hypospadias. Dorsal hooded foreskin chordee abnormal ventral meatus scrotum Hypospadias is a complex...
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Transcript of Hypospadias. Dorsal hooded foreskin chordee abnormal ventral meatus scrotum Hypospadias is a complex...
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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