Hypospadias Flashcards
How common is it
1 in 300 live births
Definition
Urethral opening on ventral side of the penis proximal to the glans
Classification: site
Glandular Coronal Subcoronal Distal penile Midshaft Proximal penile Penoscrotal Scrotal Perineal
Associated abnormalities
Undescended testes (if bilateral may be phenotypic female) Urinary tract abnormalities
Aetiology (embryology, genetic, maternal, other)
Failure of the fusion of urethral folds over ventral penis. Fusion starts posterior end and extends forward along penile shaft to the tip.
Multifactorial inheritance
Environmental
Maternal ingestion of progestational hormones in first trimester
Intersex states, undescended testis, inguinal hernia
Symptoms
Unable to direct stream of urine
Chordee interferes with intercourse
Infertility
Signs
Opening in abnormal position
Chordee of penis
Management
Specialist referral and surgical correction
Why avoid circumscision
Foreskin used in repair
Purpose of correction
Meatus on glans
Straight erection
Timing of operation
Aged 2-3 years, before school aged
Two surgical options
One stage or two stage repair
Complications (4)
Urethral stenosis
Embarrassment
Fistula
Sexual dysfunction
