What is Hypospadias?
Urethral opening proximal or ventral to the normal granular location.
Caused due to arrested penile development
Characteristics:
- Ventral meatus
- Ventral curvature
- Dorsal hood of prepuce
Defects:
- Downward glans tilt
- Deviation of the median penile raphe
- Ventral curvature
- Midline scrotal cleft
- Scrotal encroachment onto the penile shaft
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Development of Hypospadias:
Cloacal endoderm:
- Primitive urethral plate, ventrally
Medial endoderm:
- Male urethra, ventrally
Lateral Ectoderm:
- Skin of penile shaft and prepuce
- Layers fuse posteriorly to anteriorly, forming median raphe.
- Arrest in fusion causes hypospadias
- Abnormal development of growth plate, disproportionate corpora and fibrosis leads to penis curvature
Main Differential Diagnosis:
Characterized by asymmetrical perpetual development but normal granular meatus
Varient terms:
- Almost 1 out of 300 males affected by this disease.
- Risk is 13 fold in 1st degree relatives
- 8% patients have father with hypospadias, 14% have male siblings with hypospadias.
- Some are under hypospadias treatment
Risk Factors of Hypospadias in Next Child:
If your one child has hypospadias than the next one also affected and need hypospadias treatment.
- 12% with negative family history
- 19% if cousin or uncle has hypospadias
- 26% if father or sibling has hypospadias
- Placental dysfunction
- Low birth weight
- Preterm birth
- Pre pregnancy maternal obesity
- Extreme of maternal age
- Assistive reproductive techniques
Hypospadias Associated with Normalies:
- Undescended testes of 9% chances
- Inguinal hernias 9% chances
- Upper urinary tract anomalies
- Utriculus masculinus is incomplete mullerian duct regression
- Intersexuality needs to be ruled out especially in cases of non-palpable testis
Syndrome:
- 90% are isolated penile defects. Rest are syndrome namely.
- Smith lemli Optiz syndrome
- WAGAR syndrome
- Wolf Hirschorn syndrome
- 13p deletion
- Hand foot uterus syndrome
Types of Hypospadias:
Anterior hypospadias:
- Granular
- Coronal
- Subcoronal
Middle:
- Distal Penile
- Mid shaft
- Proximal penile
Posterior hypospadias:
- Penoscrotal
- Scrotal
- Perineal
Diagnosis and Hypospadias Treatment:
Zaib Hospital have specialist Andrologist doctors for hypospadias treatment in Lahore.
- Diagnosis is clinical
- Imaging not required in cases of isolated hypospadias, regardless of severity
- Surgery is the hypospadias treatment of choice
- Performed at the age of 3 months or later
If you want more information call us 03171172688 or LIVE CHAT with our experts…!
Features of Hypospadias:
- 90% hypospadias are isolated, only 10% are syndromic
- Urinary tract imaging is not required for isolated cases
- Surgery is the hypospadias treatment of choice to performed at the age of 3 months or older
- Penile blocks are considered superior to caudal blocks for surgery owing together risk of penile engorgement
- Ventral curvature at greater than 30 degree, corrected by dorsal plication
- More than 30 degree by degloving and dissection
- Tubularised preputial flaps have better outcomes as compared to only flaps
- For distal repairs follow up is desired at 2 months and 8 months post operatively, while for proximal repairs, annual follow up is recommended till puberty
Risk Factors and Complications:
- Proximal meatus
- Re operation
- Glans width less than 14 mm
- Fistula
- Glans dehiscence
- Meatal stenosis
- Neourethral stricture
- Diverticulum at the flap site
- BXO
- Graft contractions
- Obstructive urinary symptoms
- Sexual dysfunction
If you want more information about hypospadias treatment call us 03171172688 or LIVE CHAT with our experts…!
