Dr. Mirgon Fuentes Quintana

Urólogo-Pediatra TiSBU.

DEFINICION

• Hipospadia, es definida como la hipoplasia

de los tejidos que forman la parte ventral

del pene mas allá de la división del cuerpo

esponjoso con presencia de meato

ectópico ventral.

Keays MA, Dave S. Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes. Can Urol Assoc J. 2017 Jan-

Feb;11(1-2Suppl1):S48-S53.

• Incidencia- 1/250 recién nacidos

• asociado a 3 anomalías.

apertura ventral anormal del meato

uretral

curvatura ventral anormal del pene

distribución anormal del prepucio con capuchón dorsal.

Keays MA, Dave S. Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes. Can Urol Assoc J. 2017 Jan-

Feb;11(1-2Suppl1):S48-S53.

DIAGNOSTICO

• Hipospadia es diagnosticada por el examen físico,

sospechada inicialmente por la disposición del

prepucio y confirmada por la ubicación ventral del

meato.

Keays MA, Dave S. Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes. Can Urol Assoc J. 2017 Jan-

Feb;11(1-2Suppl1):S48-S53.

• Otros hallazgos incluyen

1. Glande hundido

2. Desviación del rafe medio.

3. Curvatura Ventral

4. Escroto bífido

5. transposición penoscrotal

Keays MA, Dave S. Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes. Can Urol Assoc J. 2017 Jan-

Feb;11(1-2Suppl1):S48-S53.

EMBRIOLOGIA

ETIOLOGIA

Factores Geneticos

• Relación familiar en 4% to 10% de los casos de

hipospadia, incluyendo familiares de 1er 2do y 3er

grado.

Mutaciones Geneticas

Estudios en ratones indican los gene Fgf8, Fgf10, y Fgfr2

que participan en los receptores androgénicos como

posibles candidatos en la fisiopatología de la

hipospadia.. Bouty A, Ayers KL, Pask A, Heloury Y, Sinclair AH. The Genetic and Environmental Factors Underlying

Hypospadias. Sex Dev. 2015;9(5):239-259.

ETIOLOGIA

tratamiento con progesterona durante el embarazo aumenta el riesgo

de hipospadia en el neonato.

En la mayoría de los casos este defecto congénito no esta del todo

comprendido.

Bouty A, Ayers KL, Pask A, Heloury Y, Sinclair AH. The Genetic and Environmental Factors Underlying

Hypospadias. Sex Dev. 2015;9(5):239-259.

ANOMALIAS ASOCIADAS

• Criptorquidia

• Utrículo Prostatico

•

• Agenesia Renal

CLASIFICACION

Indicaciones de cirugía

1. meato proximal

2. curvatura ventral acentuada

3. estenosis de meato

indicaciones cosméticas fuertemente ligadas a un buen

desarrollo psicológico del niño:

1. meato de localización anormal

2. glande achatado

3. pene rotado con rafe anormal

4. capuchón prepucial

5. escroto bífido.

cuando operar?

Entre 6 y 12 meses

• El proceso de cicatrización es menor y mas rápido.

• Los lactantes quedan sin secuelas psicológicas del

trauma quirúrgico en esa edad.

Springer A. Assessment of outcome in hypospadias surgery - a review. Front Pediatr. 2014;2:2.

Actualmente existe controversia en el uso de andrógenos pre quirúrgicos en cirugía de hipospadias.

preparacion hormonal prequirugica?

IM testosterona enantato – 2mg/kg/dosis durante 3 a 6

semanas una dosis semanal.

Springer A. Assessment of outcome in hypospadias surgery - a review. Front Pediatr. 2014;2:2.

Serafeddin. tratando estenosis de meato en niños con

hipospadia.

ORTOPLASTIA

• corrección de la curvatura ventral

• tejidos ventrales: piel, dartos, cuerpo

esponjoso, placa uretral , y túnica del cuerpo

cavernoso. todos ellos creando tensión para

producir curvatura ventral.

• ocurre en 11% de hipospadia distal, 30%

medio peneana, 81% en proximal.

• para evaluar la curvatura real el primero paso es tener

el pene en erección total.

• otro requisito es tener el pene liberado del prepucio.

• técnica de Baskin: las

curvaturas mayores de

30º pueden ser resueltas

con plicaturas dorsales

en la línea media.

técnica de Nesbit:

• apertura longitudinal y

cierre transversal

pudiendo ser necesaria la

escisión de piel en el

segmento contralateral a

la curvatura.

• tratamiento de la

parte ventral:

• corporotomia Ventral con

injerto.

• multiple

corporotomia

ventral sin injerto.

• injerto dermico– Devine and Horton.

URETROPLASTIA

hipospadia distal :

• TIP

• otros como MAGPI, Mathieu flip-flap, y avance

utetral.

hispospadia medio peneana:

• TIP

• Onlay con flap prepucial

hipospadia proximal :

• Reparación en dos tiempos como Byers flap o con la

técnica de Bracka .

• TIP

• Onlay con flap prepucial

HIPOSPADIA PROXIMAL

Snodgrass technique for hypospadias repair WARREN T. SNODGRASS Department of Paediatric Urology, Children's Medical Center of Dallas and University of Texas South-western Medical Center at Dallas, TX, USA

Snodgrass technique for hypospadias repair WARREN T. SNODGRASS Department of Paediatric Urology, Children's Medical Center of Dallas and University of Texas South-western Medical Center at Dallas, TX, USA

Snodgrass technique for hypospadias repair WARREN T. SNODGRASS Department of Paediatric Urology, Children's Medical Center of Dallas and University of Texas South-western Medical Center at Dallas, TX, USA

Snodgrass technique for hypospadias repair WARREN T. SNODGRASS Department of Paediatric Urology, Children's Medical Center of Dallas and University of Texas South-western Medical Center at Dallas, TX, USA

Snodgrass technique for hypospadias repair WARREN T. SNODGRASS Department of Paediatric Urology, Children's Medical Center of Dallas and University of Texas South-western Medical Center at Dallas, TX, USA

Snodgrass technique for hypospadias repair WARREN T. SNODGRASS Department of Paediatric Urology, Children's Medical Center of Dallas and University of Texas South-western Medical Center at Dallas, TX, USA

HIPOSPADIA MEDIO PENEANA

Snodgrass technique for hypospadias repair WARREN T. SNODGRASS Department of Paediatric Urology, Children's Medical Center of Dallas and University of Texas South-western Medical Center at Dallas, TX, USA

Snodgrass technique for hypospadias repair WARREN T. SNODGRASS Department of Paediatric Urology, Children's Medical Center of Dallas and University of Texas South-western Medical Center at Dallas, TX, USA

Snodgrass technique for hypospadias repair WARREN T. SNODGRASS Department of Paediatric Urology, Children's Medical Center of Dallas and University of Texas South-western Medical Center at Dallas, TX, USA

HIPOSPADIA PROXIMAL

COMPLICACIONES

• Sangrado, Hematoma

• Estenosis de meato

• Fistula

• Estenosis de uretra,

• Divertículo Uretral

• Infección

• Dehiscencia de glande

• cirugía de hipospadia fundamentada.

estandarización de abordaje

Platinum Priority – Pediatric UrologyEditorial by Antonella Giannantoni on pp. 1190–1191 of this issue

Trends in Hypospadias Surgery: Results of a Wor ldwide Survey

Alexander Springer *, Wilfr ied Krois, Ernst Horcher

Department of Paediatric Surgery, Medical University of Vienna, Austria

1. Introduct ion

Hypospadias is the most common malformation of the

penis, and literally countless techniques for its repair have

been described [1]. In large, systematic reviews of various

types of hypospadias correction, no urethroplasty tech-

nique appears to be definit ively superior. Moreover,

comparison between series in the literature is challenging

because of a lack of reliability in reporting outcome, which

complicates creation of universal recommendations [2–4] .

In 2009, the European Association of Urology published

guidelines for the treatment of hypospadias, with a level of

evidence between case series and systematic reviews of

cohort studies with or without homogeneity [5]. In clinical

practice, many factors influence the choice of surgical

technique, including ‘‘personal taste, upbringing, situation-

al preference, training, experience and personal success’’

[6]. For that reason, we sought to determine which

EU RO PEA N U ROL OGY 6 0 ( 2 0 1 1 ) 1 1 8 4 – 1 1 8 9

av ai l ab l e at w w w .sc i en ced i r ect .co m

j o u r n al h o m ep ag e: w w w .eu r o p ean u r o l o g y .co m

Art icle info

Article history:

Accepted August 11, 2011

Published online ahead of

print on August 22, 2011

Keywords:

Chordee

Hypospadias

Questionnaire

Survey

TIP

Two stage repair

Abstract

Background: Hypospadias is a challenging field of urogenital reconstructive surgery,

w ith different techniques currently being used.

Objective: Evaluate international trends in hypospadias surgery.

Design, sett ing, and part icipants: Paediatric urologists, paediatric surgeons, urologists,

and plastic surgeons worldwide were invited to part icipate an anonymous online

questionnaire (http://www.hypospadias-center.info).

Measurements: General epidemiologic data, preferred technique in the correction of

hypospadias, and preferred technique in the correction of penile curvature were

gathered.

Results and limitat ions: Three hundred seventy-seven part icipants from 68 countries

returned completed questionnaires. In distal hypospadias (subcoronal to midshaft), the

tubularised incised plate (TIP) repair is preferred by 52.9–71.0% of the part icipants.

Meatal advancement and glanuloplasty (MAGPI) is stil l a preferred method in glandular

hypospadias. In the repair of proximal hypospadias, the two-stage repair is preferred by

43.3–76.6%. TIP repair in proximal hypospadias is used by 0.9–16.7%. Onlay flaps and

tubes are used by 11.3–29.5%of the study group. Simple plication and Nesbit ’s proce-

dure are the techniques of choice in curvature up to 308; urethral division and ventral

incision of the tunica albuginea with graft ing is performed by about 20% of the

part icipants in severe chordee. The frequency of hypospadias repairs does not influence

the choice of technique.

Conclusions: In this study, we ident ified current international trends in the management

of hypospadias. In distal hypospadias, theTIPrepair is thepreferred technique. In proximal

hypospadias, the two-stage repair is most commonly used. A variety of techniques are

used for chordee correction. This study contains data on the basis of personal experience.

However, future research must focus on prospective controlled trials.

# 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.

* Corresponding author. Department of Paediatric Urology, Leeds Teaching Hospitals, Leeds, UK.

Tel. +44 7412 690107.

E-mail address: alexander.springer@meduniw ien.ac.at (A. Springer).

0302-2838 /$ – see back matter # 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.eururo.2011.08.031

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