Hypospadias_Flashcards (1)

Question 1

What is hypospadias?

Answer 1

Hypospadias is a congenital abnormality of the penis.

Question 2

What is the incidence of hypospadias in male infants?

Answer 2

Hypospadias occurs in approximately 3/1,000 male infants.

Question 3

Is there a genetic element to hypospadias?

Answer 3

Yes, there appears to be a significant genetic element with a risk of around 5-15% for further male children.

Question 4

How is hypospadias usually identified?

Answer 4

Hypospadias is usually identified on the newborn baby check.

Question 5

What might parents notice if hypospadias is missed at the newborn baby check?

Answer 5

Parents may notice an abnormal urine stream if hypospadias is missed.

Question 6

What are the characteristics of hypospadias?

Answer 6

Hypospadias is characterised by a ventral urethral meatus, a hooded prepuce, and chordee (ventral curvature of the penis) in more severe forms.

Question 7

Where is the urethral meatus located in more severe variants of hypospadias?

Answer 7

In more severe variants, the urethral meatus may open more proximally.

Question 8

How often are the urethral openings distally located in hypospadias cases?

Answer 8

75% of the urethral openings in hypospadias cases are distally located.

Question 9

What conditions are associated with hypospadias?

Answer 9

Associated conditions with hypospadias include cryptorchidism (present in 10%) and inguinal hernia.

Question 10

What should be done once hypospadias has been identified?

Answer 10

Infants with identified hypospadias should be referred to specialist services.

Question 11

When is corrective surgery for hypospadias typically performed?

Answer 11

Corrective surgery for hypospadias is typically performed when the child is around 12 months of age.

Question 12

Why should a child with hypospadias not be circumcised prior to surgery?

Answer 12

The child should not be circumcised prior to the surgery as the foreskin may be used in the corrective procedure.

Question 13

Is treatment always needed for boys with very distal hypospadias?

Answer 13

No, boys with very distal hypospadias may not need treatment.

Question 14

summarise hypospodias

Answer 14

Hypospadias

Hypospadias is a congenital abnormality of the penis which occurs in approximately 3/1,000 male infants. There appears to be a significant genetic element, with further male children having a risk of around 5-15%.

It is usually identified on the newborn baby check. If missed, parents may notice an abnormal urine stream.

Hypospadias is characterised by
a ventral urethral meatus
a hooded prepuce
chordee (ventral curvature of the penis) in more severe forms
the urethral meatus may open more proximally in the more severe variants. However, 75% of the openings are distally located.

Hypospadias most commonly occurs as an isolated disorder. However, associated conditions include cryptorchidism (present in 10%) and inguinal hernia.

Management
once hypospadias has been identified, infants should be referred to specialist services
corrective surgery is typically performed when the child is around 12 months of age
it is essential that the child is not circumcised prior to the surgery as the foreskin may be used in the corrective procedure
in boys with very distal disease, no treatment may be needed.

Question 15

You have been asked by a midwife to complete a newborn examination on a 12-hour old neonate. The parents have noticed that his penis looks abnormal and ask if you could please have a look at this. On examination, you note his urethral meatus is located on the ventral aspect of the glans and he has a hooded prepuce. He has passed urine with a good stream observed by the midwife earlier in the day.

How should the doctor proceed?

Refer to a specialist for possible surgery around 12 months of life
Refer to a specialist for surgery in the first 1 month of life
Refer to a specialist for urgent surgery within 4 hours
Tell parents no referral or further review is needed
Tell parents they should ensure he is circumcised

Answer 15

Refer to a specialist for possible surgery around 12 months of life

Hypospadias surgery is typically performed at around 12 months of age

Refer to a specialist for possible surgery around 12 months of age is correct. This is considered optimal timing taking many factors into account, including developmental milestones, tolerance of surgery and anaesthesia, size of the penis. It is referred to the specialist at the time of the diagnosis.

Refer to a specialist for surgery in the first 1 month of life is incorrect. This child has anterior hypospadias and is passing urine without problems, and therefore he has no indications for an urgent referral. An indication for a more urgent referral would be failure or difficulty to pass urine.

Refer to a specialist for urgent surgery within 4 hours is incorrect as this is not an urgent or life-threatening issue. An indication for a more urgent referral would be failure or difficulty to pass urine.

Telling parents no referral or further review is needed is incorrect. Hypospadias always requires a specialist referral even if mild. It is the specialist’s responsibility alongside the parents to decide whether surgery is required.

Tell the parents they should ensure he is circumcised is incorrect. It is important to tell parents to NOT circumcise their child with hypospadias, as the prepuce may be used during corrective surgery.

Question 16

The midwife has asked you to perform a newborn examination on a 1-day-old baby boy. He was born in good condition by vaginal delivery at 38+6 weeks gestation weighing 3400 grams. You take a brief antenatal history and are told the antenatal scans were normal and it was a low-risk pregnancy. There is no family history of congenital disorders. You proceed with your examination, and on examining the external genitalia you notice a ventral urethral meatus.

What condition is associated with the above findings?

Complete androgen insensitivity syndrome
Cryptorchidism
Renal agenesis
Turner’s syndrome
Umbilical hernia

Answer 16

Cryptorchidism

Cryptorchidism is present in around 10% of patients with hypospadias

This question addresses your awareness of conditions associated with hypospadias. In most children, hypospadias will be an isolated abnormality and the neonate will have no other issues. However, in any case of congenital malformation it is always important to consider other possible malformations and actively look for these. Many congenital issues do not exist in isolation. Conditions associated with hypospadias are cryptorchidism and inguinal hernias.

Cryptorchidism is correct. 1 in 10 children with hypospadias will also have cryptorchidism (undescended testes). Therefore, it is always important to examine the groin and scrotum in children with hypospadias as done in the above scenario. It is also important to ensure they have passed urine in the first 24 hours of life.

Complete androgen insensitivity syndrome (CAIS) is incorrect. People with CAIS would develop female external genitalia. In partial androgen insensitivity syndrome, the external genitalia may appear as male or female.

Renal agenesis is incorrect. While both are disorders of the urinary system, they are not classically seen together.

Turner’s syndrome is incorrect. Turner’s syndrome is a genetic condition that affects females. Someone affected by Turner’s syndrome would only have one complete X chromosome (45, X0). They would have external female genitalia and thus it is not associated with hypospadias.

Umbilical hernia is incorrect. Hypospadias is commonly associated with an inguinal hernia, not an umbilical hernia.