Hypospadias

Question 1

What is hypospadias?

Answer 1

• Congential defect
• Urethral meatus located at abnormal site
• Usually on underside of penis rather than tip

Question 2

Cause of hypospadias

Answer 2

• Arrest in penile development
• Leading to hypoplasia of ventral tissue of penis

Question 3

3 key features of hypospadias

Answer 3

• Ventral opening of urethral meatus
• Ventral curvature of penis or ‘Chordee’
• Dorsal hooded foreskin

Not all 3 needed to diagnose though

Question 4

Classification of hypospadias

Answer 4

• Glandular
• Coronal
• Shaft (distal, mid, proximal)
• Scrotal
• Perineal

Based on location of urethral meatus

Question 5

Diagnosis to rule out in hypospadias

Answer 5

• Eliminate underlying disorder of sexual development
• If associated with unilateral or bilateral undescended testes congenital adrenal hyperplasia should not be missed
• Consider if ambigious genitalia
• If missed could lead to salt wasting crisis due to cortisol and aldosterone deficiency with androgen excess

Question 6

Investigations for hypospadias

Answer 6

• If not concerned about sexual development disorder - no other investigations
• If you are: Karyotype, pelvic USS, U&E, endocrine hormones eg testosterone, LH, FSH, ACTH, renin, aldosterone

Question 7

Management hypospadias

Answer 7

• Urethroplasty - single stage or 2 stage using graft
• Preferentiallly a preputial graft harvested from foreskin (circumcision advised against)

Question 8

Aim of urethroplasty

Answer 8

• Bring meatus to the glans of the penis
• Chordee corrected to straighten penis
• Dorsal foreskin managed with circumcision or reconstruction

Question 9

Short term complications of hypospadias

Answer 9

• Catheter after surgery - may become blocked, displaced or kinked
• Catheter can also cause pain and bladder spasms (check draining and then can treat with oxybutynin)
• Bleeding
• Infection

Question 10

Longer term complications

Answer 10

• Urethral fistula
• Meatul or urethral stenosis