Hypospadias. Dorsal hooded foreskin chordee abnormal ventral meatus scrotum Hypospadias is a complex...
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Transcript of Hypospadias. Dorsal hooded foreskin chordee abnormal ventral meatus scrotum Hypospadias is a complex...
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Hypospadias
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Dorsal hooded foreskin
chordee
abnormal ventral meatus
scrotum
Hypospadias is a complex of an abnormal ventral meatus, chordee, and a dorsal hooded foreskin. Usually isolated, it can be part of the DSD spectrum.
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Incidence: one in 300 live-births (but wide variation from 1 in 110 to 1 in 1,250)
Rising incidence Associating with inguinal hernia and hydro
cele (~10%), undescended testes (~8%)
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EmbryologyThe development of male urethra takes plac
e between the 8th and the 15th week of gestation under the influence of testosterone.
EtiologyMultifactorial involving genetic, endocrine, a
nd environmental factors.
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Genetic Factors
Inheritance is unknown.The following facts:
Monozygotic twins – eightfold increase in the incidence of hypospadias
family history – 8% of fathers and 14% of brothers
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Endocrine Factors
Deficient androgenic stimulation Increased maternal progesterone exposure
Environmental Factors ↑Incidence of hypospadias and one hypoth
esis suggests that there is increased maternal exposure to estrogenic substances (contained in pesticides, milk, plastic linings of metal cans, and pharmaceuticals).
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Clinical Features
Classification Distal (glanular, coronal, and subcoronal) (5
0%) Middle (distal penile, midshaft, and proximal
penile) (30%) Proximal (penoscrotal, scrotal, and perinea
l) (20%)
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Surgery
Principles The goal of surgery is to create a
cosmetically acceptable penis, which allows normal voiding with a forward stream and normal vaginal penetration.
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Preoperative completing the repair of hypospadias before 18
months of age (minimizes psychological impact of genital surgery).
Hormone manipulation correction of chordee Urethroplasty Meatoplasty and glanuloplasty Skin coverage
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Postoperative
Early complications
bleeding, hematoma, infection, and breakdown of repair.
Long-Term Outcome persistent chordee, meatal stenosis, urethrocu
taneous fistula, urethral stricture, and urethral diverticulum. The incidence is highly variable though.
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Thank you!