GU - Hypospadias

Question 1

Definition

Answer 1

Condition affecting males = urethral meatus (opening of the urethra) is abnormally displayed to the ventral side (underside) of the penis towards the scrotum.

Question 2

Epidemiology

Answer 2

Congenital condition = affecting babies from birth and usually diagnosed on the examination of the newborn
- Males

Question 3

Types

Answer 3

• Subcoronal
• Midshaft
• Penoscrotal

Question 4

Pathophysiolgy

Answer 4

Urethral meatus = abnormally displaced to the ventral side of the penis, towards the scrotum.
This might be further towards the bottom of the glans (in 90% of cases), halfway down the shaft or even at the base of the shaft

Question 5

Epispadias

Answer 5

Where the meatus is displaced to the dorsal side of the penis.

Question 6

Signs

Answer 6

• Ventral urethral meatus
• A hooded prepuce: Usually the foreskin is abnormally formed to match the position of the meatus.
• There can also be an associated condition called chordee, where the head of the penis bends downwards, inguinal hernia and cryptochidism

Question 7

Symptoms

Answer 7

Difficulty with targeting
Incontinence

Question 8

Diagnosis

Answer 8

Examination of newborn
Excretory urogram

Question 9

Management

Answer 9

Referral to a paediatric specialist urologist for ongoing management.
- Mild cases may not require any treatment
- Corrective surgery is typically performed when the child is around 12 months of age
- It is essential that the child is not circumcised prior to the surgery as the foreskin may be used in the corrective procedure
- Surgery aims to correct the position of the meatus and straighten the penis

Question 10

Complications

Answer 10

Difficulty directing urination
Cosmetic and psychological concerns
Sexual dysfunction