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Definitions
Epidemiology
Genetic factors
Anatomy
Normal Anatomy of the Penis
Figure
2.
Anatomy of
the Penis 2.
3
Figure 3:
Anatomy of Hypospadia
Classification
Figure 4: Classification1,5
Embryology Development
Hypospadias results from a failure of tubularization of
the horizontal segment of the urogenital sinus: 4
during the 11th week of gestation for the penile
urethra
during the 4th month of gestation for the
glanular urethra
Figure 6: Embryology4
Associated Conditions
Cryptorchidism 7% 3
Prostatic Utricle1 : 27.5%6
Disorders of Sex Development :
50% of patients with a nonpalpable testis and
hypospadias.3
Intersex conditions occur in approximately 15%.7
Malformation Syndromes 3
Micropenis
Clinical Findings
A. SYMPTOMS AND SIGNS8
Newborn and young children: seldom
Older children and adults difficulty directing the urinary
stream and stream spraying
Chordee
Voiding in the sitting positionPerineal or penoscrotal
hypospadias.
Abnormal (hooded) appearance of the penis
The hypospadiac meatus may e stenotic
B. LABORATORY, X-RAY, & ENDOSCOPIC FINDINGS8
A buccal smear and karyotyping
o indicated to help establish the genetic sex.
Urethroscopy and cystoscopy
Treatment
SURGICAL PRINCIPLES2,4
1. Straightening of the penis (i.e., correction of chordee)
2. Reconstruction of the missing urethra (i.e., urethroplasty)
3. Reconstruction of the tissues forming the ventral radius of the
penis (i.e., glans, corpus spongiosum, and skin).
5 Sequential Steps for the Successful Repair of
Hypospadias2,9
1. Orthoplasty or penile straightening
2. Urethroplasty
3. Meatoplasty and Glanuloplasty
4. Scrotoplasty
5. Skin Coverage.
ORTHOPLASTY
V. Thiersch-Duplay Procedure
COMPLICATION10
1. Fistulas Urethrocutaneus Fistulas
Steps to decrease risk for fistula
a. subepithelial sutures to turn epithelial edges into the
neourethra
b. 2-layer urethroplasty
c. Interposition of tissue flaps, including dartos, corpus
spongiosum, and/or tunica vaginalis, between the
neourethra and shaft skin closures.
2. Meatal Stenosis
o Result from technical errorstubularizing the neourethra
too far distally
o vascular compromise.
3. Urethral Stricture
Recurrent or longer strictures best be repaired using
single stage dorsal inlay grafts.
4. Urethral Diverticulum Excision of the excessive skin.
5. Wound Dehiscence
Reoperation is performed 6 months later
10
Sidik-Chaula Urethroplasty
Stage One
Stage Two
Bracka-Snodgrass Urethroplasty
References
1. Hipospadia. Modul Bedah Plastik FKUI. Modul no : 36
2. Sukasah CL, Supit L, Mukarramah DA, Ramadan R. Illustrated
Guideline of Hypospadia Surgery. Lingkar Studi Bedah Plastik.
2013
3. Wein AJ, Kavoussi LR, Partin AW, Novick AC. Hypospadias. In:
Campbell-Walsh Urology 10th edition. Elsevier 2012;130
pg;3504
4. Mouriquand PDE, Demede D, Gorduza D, Mure PY.
Hypospadias. In: Pediatric Urology 2nd Ed. Saunders. 2001
5. Hadidi AT. Hypospadia Surger. In:International Workshop on
Hypospadias Surgery, Medical University Vienna, 2006
6. Ikoma F, et al. Classification of enlarged prostatic utricle in
patients with hypospadias. Br J Urol. 1985 Jun;57(3):334-7.
7. Kaefer, M., Diamond, D., Hendren, W. H. et al. The incidence of
intersexuality
in
children
with
cryptorchidism
and
hypospadias: stratification based on gonadal palpability and
meatal position. J Urol. 1999 162: 1003
8. McAninch JW. Hypospadias. In: Smiths General Urology 17 th Ed.
Lange. 2008. Pg;629.
9. Baskin LS, Ebbers MB. Hypospadias:anatomy,etiology,and
technique. J Pediatr Surg 2006;41(3):463472
10.
Snodgrass WT. Hypospadias. In: Pediatric Urology a
General Urologists Guide. Springers. USA 2011