Hypospadias And Epispadias

Question 1

What is hypospadias

Answer 1

In this defect the urethra opens on the ventral surface of the penis proximal to the normal site of the external urethral meatus. It results from the failure of the urethral groove to complete its ventral closure to the tip of the penis

Question 2

In hypospadias do the urinary sphincters function normally and why

Answer 2

They function normally
This is because they the posterior urethra is never involved, urinary incontinence is therefore not a feature

Question 3

What are some associated anomalies with hypospadias

Answer 3

The most common associations are undescended testes and inguinal hernia

Question 4

What are the clinical features of hypospadias

Answer 4

The hypospadiac penis presents a ventral curvature (chordee), the degree of curvature being more marked the more proximal the urethral opening

Question 5

The four types of hypospadias are determined by

Answer 5

The site of the urethral opening

Question 6

What are the four types of hypospadias

Answer 6

Glandular
Penile
Peno-scrotal
Perineal

Question 7

What is glandular hypospadias

Answer 7

The urethral opening is seen in the position usually occupied by the frenum which is absent . Apart from a downward direction of the urinary stream for which the penis has to be raised during micturition, symptoms are rarely present other than those due to co-existing stenosis of the meatus

Question 8

What is penile hypospadias

Answer 8

The urethral opening may be at any point along the shaft of the penis

Question 9

In anterior penile hypospadias there is likely to be little functional disturbance in the absence of urethral stenosis
True or false

Answer 9

True

Question 10

In which hypospadias could the marked chordee interfere with coitus and insemination

Answer 10

Posterior penial

Question 11

What is peno-scrotal hypospadias

Answer 11

Dwarfed flattened penis being occasionally attached to the scrotal raphe (webbed penis). The chordee in these cases results from hypoplasia and fibrosis of the corpus spongiosum

Question 12

What is the treatment for glandular hypospadias

Answer 12

Tubularized plate urethroplasty (TIP) or meatal advancement and granuloplasty (MAGPI)

Question 13

What is perineal hypospadias

Answer 13

Perineal hypospadias is rare and represents the extreme degree.The external genitalia resembles that of the female. Thus, the separated sacs of the scrotum (bifid scrotum) assume the appearance of hypertrophied labia majora and the rudimentary penis with marked chordee that of a hypertrophied clitoris. The bifid scrotum may contain normal. atrophic or no testes. The urethral orifice is funnel-shaped, wide open as a rule, and is aptly termed pseudovaginal orifice. Most persons loosely
designated as pseudohermaphrodites have perineal hypospadias. Urethroscoplc visualization of the verumontanum and the
presence of palpable testes establish the male dominance of the
patients and is confirmed by chromosome karyotype or testicular biopsy.
Sexual function is seldom realized by patients with penoscroral and perineal variations of hypospadias miniature penis with marked chordee. These male patients squat or sit to void so as not to spray urine over themselves or their clothing. Thus, male patients with perineal hypospadias are characteristically more female than male

Question 14

What is male epispadias

Answer 14

This is a congenital deformity in which the urethra opens on the dorsum of the penis at some point proximal to the glans. Dorsal curvature of the penis may also be present. It is caused by failure of union of the anterior walls of the urethra. The corpora cavernosa is loosely attached and the spongiosum is deficient

Question 15

What are the three types of male epispadias

Answer 15

Glandular
Penile
Complete

Question 16

What is the glandular type of epispadias

Answer 16

The urethral opening is immediately proximal to the glans, a dorsal groove usually indenting the glans to its tip thereby resulting in flattening of the glans. The prepuce appears as a ventral tag. There may be little disturbance of function. The penis, however,is often very short and broad and this may interfere in later life with coitus

Question 17

What are the classifications of female epispadias

Answer 17

Clitoric
Subsymphyseal
Complete

Urinary incontinence associated with the complete type is often misdiagnosed in the female as enuresis

Question 18

How is epispadias treated

Answer 18

Minor degrees of epispadias are not greatly benefitted by operation which should aim at urinary continence and correction of inability to copulate. Plastic repair of the penis requires reduction of the chordee followed by urethroplasty which advances the urinary orifice to the distal end of the shaft
Operation is done when the child is over 30 months when vesical comrol should (normally) be consciously established and tissue development greatly enhanced. The majority of patientswith incontinence cannot be made dry with bladder neck reeonsrrucrion. If this fails, an artificial sphincter is inserted or a continent catheterizing urinary diversion is undetaken

Question 19

What is penile epispadias

Answer 19

The urethral opening is situated between the post-glandular sulcus and the suspensory ligament, occurring most often at the base of the penis. A groove runs along the dorsum of the penis to the top of the glans. The prepuce hangs ventrally as a loose tag. The penis is short, patulous or spade-like in appearance with a dorsal curvature making coitus impossible in many patients. In those with satisfactory intercourse, reproduction is usually impossible because development of the prostate is either poor or absent.The urinary stream is spattered and difficult to direct

Question 20

What is complete epispadias

Answer 20

The entire length of the dorsal (anterior) wall of the urethra is absent up to the bladder neck
It is almost always associated with ectopia vesicae, separation of the symphysis pubis and rudimentary pubic bones. Since development of the urinary sphincter is poor, incontinence of urine is the rule