Hypospadias in a neonate–recognizing and managing

Question 1

Define hypospadias?

Answer 1

Occurs in male for the urethra is located on the underside of the penis rather than the tip of the penis.

Question 2

We will what is the incidence of hypospadias?

Answer 2

1 in 300 male birth

Question 3

Is there a genetic component and what would be the recurrence rate?

Answer 3

There is a strong genetic component. With a recurrence rate among male siblings a 14% and 8% recurrence rate in male offspring.

Question 4

Are there genetic syndromes that also may include hypospadias and if so what are they?

Answer 4

+The genetic syndromes that may have hypospadias include Denys-Drash syndrome, WAGR syndrome, and Opitz syndrome.

Question 5

What are other etiologic causes of hypospadias?

Answer 5

Environmental exposures, possible endocrine disruptors with maternal exposure to DES and early exposure to progesterone e.g. given for early threatened abortion.

Question 6

In general where is the urethral meatus located in the baby with hypospadias?

Answer 6

It is an abnormal ventral and more proximal placement of the urethral opening

Question 7

Describe the 4 components of a complete genital exam in the mail.

Answer 7

Management of stretched penile length
Assessment of penile curvature
Assessment of the foreskin
Confirmation of the presence of both testicles in the normal scrotal position

Question 8

What are the 3 classifications of of hypospadias?

Answer 8

Standard hypospadias
Severe hypospadias
Form fruste

Question 9

For a standard hypospadias what are the 2 subtypes and what is the rest the anatomy findings?

Answer 9

1. Distal the ectopic misplaced urethra is at the coronal edge or more distal
2. Proximal: The ectopic urethra is midshaft or lower towards the scrotum
   The penis is normal, and the curvature is typical within normal.

Question 10

And severe hypospadias describe the anatomical findings?

Answer 10

The urethral opening is in the scrotum. And there may be an associated micropenis defined as less than 2.5 cm stretched length and full-term infants and there may be presence of a severe chordee.

Question 11

What are comorbid findings in males with severe hypospadias?

Answer 11

They are more likely to have other nongenital anomalies and
There are also seen often with cryptorchidism

Question 12

Discussed the anatomical findings for forme fruste type of hypospadias?

Answer 12

There appear to be 2 urethras at the tip of the glans however 1 is a blind pit furthermore they may have asymmetry of the foreskin.

Question 13

What are the for other variants seen with or associated with hypospadias?

Answer 13

1. Megameatus
2. Chordee with normal meatus
3. Cryptorchidism
4. Incomplete foreskin

Question 14

What is a megameatus and physical findings?

Answer 14

A large urethral opening often times described as “catfish” mouth.

Question 15

What are anatomical findings for chordee with normal meatus?

Answer 15

Chordee refers to a congenital penile curvature in which the penis bends or twists when erect.

Question 16

What are the anatomical findings in cryptorchidism and what else should be ruled out?

Answer 16

And undescended testes he or testes and if it is associated with hypospadias then there may be a high probability of a disorder of sexual development or ambiguous genitalia,

Question 17

What is a dorsal hooded foreskin?

Answer 17

Describes the foreskin or ventral part of the foreskin and missing.

Question 18

Describe the management for standard hypospadias

Answer 18

Referral to a urologist before circumcision

Question 19

For severe hypospadias what labs should be obtained to rule out comorbidities?

Answer 19

Obtain a karyotype to confirm the presence of Y chromosome and consider serum electrolytes to screen for congenital adrenal hyperplasia.

Question 20

What are the treatment options for forme fruste

Answer 20

Identifying the defect and then if possible continue with circumcision if it is minor there is no urology referral needed. However if it is a little bit more complicated then the circumcision should be performed in the operating room.

Question 21

Described the treatment for megameatus.

Answer 21

Referral to urology for possible urethroplasty. If the circumcision was not completed then delay and refer to urology

Question 22

what are the treatment options for chordee with normal urethral meatus?

Answer 22

Delay circumcision until approximately 6 to 12 months of age and refer to urology.

Question 23

what should be done for micropenis?

Answer 23

When there is a combination of hypospadias and micropenis, hormone therapy can be considered (testosterone therapy once per month for 3 months)