2022 - Hypospadias Flashcards
What is hypospadias, and what does it include?
Hypospadias is a common congenital anomaly in boys with a prevalence of 1 in 150 to 300 live births. It includes a dorsally hooded foreskin, an ectopic urethral meatus, and ventral penile curvature. Severity varies, and in mild cases, surgery may not be necessary.
How was hypospadias traditionally classified, and what are the current important considerations?
Hypospadias was traditionally classified based on the location of the urethral meatus, with 70%–85% having a distal variant and 10%–25% a proximal variant. Now, the degree of penile curvature, glans anomaly, and shaft skin deficiencies also play a role in classification and complications.
What is the prevalence of hypospadias in the United States, and what does it imply for adult urology practice?
Hypospadias occurs in 1:200 male births in the United States. Though not all undergo surgery, the cumulative number necessitates an understanding for the adult urology practice.
What are the goals of penile reconstruction in patients with hypospadias?
The goals include allowing the boy to void upright with normal velocity and laminar flow, obtaining satisfactory sexual function with a straight penis, and creating an orthotopic meatus with a well-approximated glans. The varied nature of hypospadias makes this a unique challenge.
What are the success rates and common complications of distal and proximal hypospadias repairs?
Distal hypospadias repairs have an 85%–95% success rate, while proximal repairs have higher complications (35%–68%). Common complications include urethrocutaneous fistula, glans dehiscence, meatal stenosis, recurrent chordee, stricture disease, and diverticula.
What is the most common complication after hypospadias repair, and how is it managed?
The most common complication is urethrocutaneous fistula, with a 10% incidence. Causes are multifactorial, and management depends on factors like number, size, and location. Primary repair or redo urethroplasty might be required.
What is glans dehiscence, and when does it occur?
Glans dehiscence is a complication identified early postoperatively, usually resulting from undue tension on the glans closure. Reoperation may not be necessary unless voiding symptoms are bothersome.
What causes meatal stenosis, and how is it treated?
Meatal stenosis may occur when the neomeatus is extended too far or due to a technical issue with incomplete glans wing dissection. Treatment may include repair, conservative management with topical steroids and dilation, or re-do urethroplasty.
What are the considerations in managing urethral stricture after hypospadias repair?
Urethral stricture’s management depends on the caliber, location, and length of the stricture. Treatment may include dilation, direct vision urethrotomy, or revision urethroplasty with buccal mucosal graft or local skin flaps.
What is urethral diverticula, and what are its common symptoms?
Urethral diverticula is a complication that may cause post-void dribbling, weak stream, ventral penile bulge with voiding, or UTIs. It is more common after specific repairs, including proximal repairs, due to the lack of natural spongiosal tissue reinforcement.
How is ventral curvature associated with proximal hypospadias managed?
Ventral curvature in proximal hypospadias must be objectively measured. Mild curvature (<30 degrees) can be managed with dorsal plication, while moderate to severe curvature requires ventral lengthening.
Why is extended follow-up essential after hypospadias repair?
Extended follow-up is crucial to recognize complications, as many occur after the first year, and some even more than 5 years postoperatively. Surgeons should follow patients through puberty to identify high-risk individuals.
How is postoperative urinary function assessed after hypospadias repair, and what are common findings?
Postoperative urinary function assessment includes office uroflowmetry (UF), revealing normal maximum urine flow rate (Qmax) values but below the 50th percentile compared to age-matched controls. Obstructive flow rates vary between distal (15%–33%) and proximal (75%) repairs.
What lower urinary tract symptoms may adult patients present after hypospadias repair?
Adult patients may present with symptoms like slow/weak stream (15.1%), spraying/splayed stream (30%), or post-void dribbling (29.6%). These symptoms are reported twice as often in patients with hypospadias repair, and underlying pathological causes should be investigated.
How can hypospadias surgeries during infancy affect sexual function and satisfaction?
Hypospadias surgeries can have lasting effects on sexual behavior and self-esteem. Recent literature shows comparable sexual debut, interest, libido, and satisfaction with controls. Surgical efforts aim to preserve erectile function and sensation.
