HYPOSPADIAS

Presenter:
Dr Muhammad Saaiq
NORMAL PENILE ANATOMY

Normally the male urethra develops between the 8th

and 15th weeks of gestation under the influence of
testosterone.
From inside out there are:
2 Corpora Cavernosa, 1 Corpus Spongiosum
enclosed in a fascial sheath- Tunica Albuginea

Bucks Fascia, Thick Fibrous Envelope.

Connective Tissue, Dartos Fascia, and Skin.

 HYPOSPADIAS

Hypo- below, Spadon- orifice

Congenital anomaly characterized an abnormal

Urethral meatus locate dabnormally proximal
and ventral on the penis, scrotum or perineum.

Incidence ……..1/100 to 1/300 live births.

 Dorsal hooded foreskin

Chordee

Scrotum

Abnormal ventral
meatus
 CLINICAL FEATURES

‰Abnormal ventral meatus,

‰Hooded prepuce (98%)
‰Chordee (15% of anterior cases, >50% of posterior
cases)
‰Meatal dystopia
‰Para-urethral sinuses Flattened glans with a cleft
‰Scrotum may be bifid
‰Penile torsion
‰Associating with inguinal hernia and hydrocele
(~10%), undescended testes (~8%), Urethral valves/VUR
‰Very rarely can be part of the DSD spectrum.
 Chordee is caused by:

1-Differential growth of the normal corpora cavernosa

and abnormal ventral structures.

2-Fibrous remnants/ dysgenetic remnants of

undifferentaited corpus spongiosum and fascial layers
of the penis which insert into the glans.
 Etiology

Multifactorial involving endocrine, genetic,

and environmental factors.

There is failure of complete fusion of the

urethral folds which may be due to
reduced testosterone stimulation.
 Endocrine Factors
1-Deficient androgenic stimulation. This may be
due to abnormalities of the 5-alpha reductase or
abnormal androgen receptors)

2-Increased maternal progesterone exposure.

The progesterone competitively inhibits the 5-
alpha reductase. Hypospadias is 5 times more
common among boys born from IVF as the
mother receives progesterone treatment during
IVF.
„ Environmental Factors

Increasing Incidence of hypospadias has

been attributed to the increased maternal
exposure to estrogenic substances
(contained in edibles, milk,
pharmaceuticals etc.).
 Genetic Factors
„ Inheritance is unknown. The following facts:
„ Monozygotic twins: 8 fold increase in the
incidence of hypospadias compared to
singletons. May be due to in utero
competition for HCG.
„ family history of the affected boys: 8%
have affected fathers and 14% have
brothers
 Classification
„

„ Anterior (glanular, coronal, and subcoronal)

(50% cases)
„ Middle (distal penile, midshaft, and
proximal penile) (20% cases)
„ Posterior (penoscrotal, scrotal, and
perineal) (30% cases)
 Goals of Surgery

1-To allow normal standing voiding with a

forward/ straight stream
2-Normal sexual function.
3- To create a cosmetically acceptable organ
with natural appearance.
CLASSIFICATION
Smith ……..

Able …….. I , II, III degree

Browne …….. Coronal - distal penile,

penile, penoscrotal, scrotal
penile

Basrat …….. (post chordee release)

DEVINE HORTON CLASSIFICATION

TYPE I :
SPONGIOSUM DEFECT

TYPE II :
BUCKS & DARTOS DEFECT

TYPE III :
DARTOS & SKIN DEFECT
SURGICAL OPTIONS
ONE STAGE PROCEDURES
a) Urethral advancement
b) Onlay techniques
c) Inlay techniques
TWO STAGE REPAIR
BRACKA
TREATMENT OPTIONS
GLANDULAR & SUBCORONAL
MAGPI
GAP
MIP
DISTAL PENILE
MATHEIU
SNODGRASS
DEVINE HORTAN
MUSTARDEE
TREATMENT OPTIONS…
MIDPENILE
SNODGRASS
ONLAY ISLAND PREPUTIAL FLAP
KING
HODGSON II
PROXIMAL PENILE
TRANSVERSE PREPUTIAL FLAP
HODGSON I
HODGSON III
TREATMENT OPTIONS…
POSTERIOR URETHRA
TRANSVERSE PREPUTIAL FLAP

TWO STAGED
BUCCAL….TUBULAR….GLANS CHANNEL
BAYRS…
CECIL
SMITH
 Complications

Early:
Bleeding, hematoma, infection, repair-
breakdown.
Late:
„ Urethrocutaneous fistula, Persistent chordee,
Meatal stenosis, Urethral stricture, Urethral
diverticulum, Hair in the urethra, Balanitis
xerotica obliterans.
Thank You