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Introduction to hypospadias for undergraduates

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  1. 1. Hypospadias Presented by : Dr. Mahmoud Motawea
  2. 2. Definition A congenital anomaly of the male urethra where the urethral opening is abnormally located on the undersurface of the penis orperineum and the ventral surface of the prepuce is poorly developed
  3. 3. Types Glanulartype Coronal meatus Penile type Penoscrotal Perineal
  4. 4. Etiology Glanulartvpe: occurs due to failure of re- canalization at the glans of penis. Penile tvpe: occurs due to failure of fusion of inner urethral folds. Perineal tvpe: occurs due to failure of development of whole penile urethra"
  5. 5. Moredetails • Occur embryologically, between 8 and 20 weeks' gestation. • As the phallus grows, the open urethral groove extends from its base to the level of the corona. • The classic theory is that the urethral folds coalesce in the midline from base to tip, forming a tubularized penile urethra and median scrotal raphe. This accounts for the posterior and middle urethra. The anterior or glanular urethra is thought to develop in a proximal direction, with an ectodermal core forming at the tip of the glans penis, which canalizes to join with the more proximal urethra at the level of the corona.
  6. 6. Clinical picture What to focus on in history taking : • any history of a familial pattern of hypospadias, any past medical history or comorbidity • Infertility of IVF.
  7. 7. Clinical picture Abnormal site of urethra Difficulty directing urine streamand stream spraying Hooded prepuce (Except Megameatus intact prepuce (MIP) variant.) Penoscrotal transposition, Bifid scrotum. Chordae …
  8. 8. Treatment Avoid circumcision ! Surgical correction principles : 1- Removai of the chordee to coi'rect the ventral curvature. 2- Urethral reconstruction using skin from the prepuce or penile skin. 3- Circumcision after that.