Hypospadias

Question 1

incidence

Answer 1

1/300 live male births

Question 2

principles of hypospadias repair

Answer 2

Regardless of the particular type of repair, there
are three specific components to the surgical correction of hypospadias:
• correction of the penile chordee
• reconstruction of the urethra (urethroplasty)
• skin coverage of the penis aimed at achieving a normal cosmetic appearance.

Question 3

formation of urethra embryology

Answer 3

Influence of DHT on androgen receptors results in differentiation of genital tubercle, genital labioscrotal folds and genital swelling between 9-13 weeks gestation into male structures of glans penis, penile shaft, and scrotum respectively

Question 4

features of hypospadias

Answer 4

• an abnormal ventral opening of the urethral meatus
• ventral curvature (chordee) of the penis
• a hooded foreskin, which is deficient ventrally.

Question 5

embryology hypospadias

Answer 5

incomplete closure of the penile structures during embryonegensis
urethral opening displaced ventrally
corpus spongiosum is divied proximal to meatus
distal to meatus urethra is hypoplastic

Question 6

Duckett classification hypospadias

Answer 6

glanular 
subcoronal 
distal penile
mid shaft
proximal penile
penoscrotal 
scrotal
perineal

Question 6

Duckett classification hypospadias

Answer 6

glanular 
subcoronal 
distal penile
mid shaft
proximal penile
penoscrotal 
scrotal
perineal

Question 7

Hadidi 2004 classification hypospadias

Answer 7

glanilar
distal - to mid shaft
then proximal

Question 8

embryological time period tubularisation urethra

Answer 8

from week 10 to week 14

Question 9

when would do work up for dsd

Answer 9

if hypospadis with unliateral or bilateral UDT

Question 10

familial risk

Answer 10

7% will have one relative affected

Question 11

when to do surgery for hypospadias

Answer 11

usually 6-18 months

Question 12

aims of hypospadias surgery

Answer 12

correct chordee
site meatus to tip of glans
cosmetic appearance
adquate voiding and sexual function

Question 13

technique operation

Answer 13

penile degloving
orthoplasty
urethroplasty
glansplasty
meatoplasty

Question 14

distal hypospadias techniques

Answer 14

MAGPI
snodgrass/TIP
Mathieu

Question 15

proximal hypospadias techniques

Answer 15

two stage repair with graft

Question 16

MAGPI

Answer 16

glanular and selected coronal hypospadias

aim to advance meatus onto glans

Question 17

TIP/snodgrass

Answer 17

urethral plate tubularised around a catheter
if urethral plate too narrow incise
can correct to mid shaft cases

deglove
urethral plate seperated from glans wings
midline relaxing incision through plate for tension free tubularisation

Question 18

interval period two stage repair

Answer 18

6 months

Question 19

first stage of graft repair

Answer 19

skin deglovement
resection chordee
transection urethral plate
graft then formed neourethral plate

Question 20

second stage

Answer 20

new formed urethral plate tubularised to create neourethra which is then covered with dorsal dartos flap

Question 21

catheter after hypospadias repair

Answer 21

try to leave in for a week in double nappy 6F feeding tube

Question 22

complications hypospadias surgery

Answer 22

glans width less than 14mm
higher risk complications
more proximal location

fistula - will rarely close spont
reduced if cover with dartos layer so not in contact penile skin

meatal stenosis when blood supply neourethra is compromised
or when urethra is sutured distally can get meatal stenosis

urethral diverticular due to urethral stenosis distally

glans dehiscence
ongoing penile curvature