Congenital And Paediatrics

Question 1

Name the condition in picture 1.

Answer 1

Hypospadias

Question 2

Name 3 features of hypospadias

Answer 2

Ventral opening of urethra
Dorsal hood
Ventral chordee

Question 3

Name 5 congenital contraindications to circumcision

Answer 3

1. Hypospadias
2. Chordee
3. Ambiguous genitalia
   4 webbed penis
4. Buried penis

Question 4

What is the most common congenital penile anomaly

Answer 4

Hypospadias

Question 5

What is the cause of hypospadias

Answer 5

Failure of the tubularisation process embryologically during week 5-8
Decreased exposure to dihydrotestosterone or 5-alpha-reductase or testosterone (pesticides, herbacides DDT, plastics)
Genetics: first degree relatives
IVF, other assisted birth

Question 6

Where is the position of the meatus most commonly found in hypospadias

Answer 6

Distal ventral opening.

Question 7

What is NB to exclude if hypospadias is found?

Answer 7

Disorders of sex development / intersex disorders.

Question 8

What is the mainstay of treatment for hypospadias?

Answer 8

Orthoplasty (straighten penis)
Urethral reconstruction: unethroplasty.
Not circumcision!

Question 9

How is hypospadias classified (7)

Answer 9

According to position of meatus:
distal 65%: granular, coronal, distal penile
middle 15%: mid-penile shaft
proximal 20%: proximal penile shaft, peno-scrotal, perineal

Question 10

At what age should hypospadias be repaired

Answer 10

6-12 mo ideally, max 18 months

Question 11

Define phimosis

Answer 11

A congenital narrowing of the opening of the foreskin so that it can’t be retracted