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HYPOSPADIAS. Dr.GOVINDRAJAN Department of Urology and Renal Transplantation SRMC & RI. NORMAL PENILE ANATOMY. 2 Corpora Cavernosa, Corpus Spongiosum Enclosed In A Fascial Sheath- T.Albuginea Bucks Fascia, Thick Fibrous Envelope Connective Tissue, Dartos Fascia. HYPOSPADIAS.

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hypospadias

HYPOSPADIAS

Dr.GOVINDRAJAN

Department of Urology and Renal Transplantation

SRMC & RI

normal penile anatomy
NORMAL PENILE ANATOMY
  • 2 Corpora Cavernosa, Corpus Spongiosum

Enclosed In A Fascial Sheath- T.Albuginea

  • Bucks Fascia, Thick Fibrous Envelope
  • Connective Tissue, Dartos Fascia
hypospadias3
HYPOSPADIAS
  • Hypo- below, Spadon- orifice
  • Urethral meatus opens on ventral side of the penis, proximal to the tip of glans penis
  • Incidence ……..1/125 to 1/250
embryology
EMBRYOLOGY
  • Cloacal membrane, genital tubercle, labioscrotal swellings
  • Androgen stimulation…phallus elongation
  • 3 phases of urethral formation
    • Posterior urethra formation
    • Anterior urethra formation
    • Glandular segment formation
  • Prepuce formation
classification
CLASSIFICATION
  • Smith ……..
  • Able ……..I , II, III degree
  • Browne ……..Coronal - distal penile, proximal penile, penoscrotal, scrotal penile
  • Basrat …….. (post chordee release)
classification location
CLASSIFICATION (LOCATION)
  • DISTAL
    • Glandular, Coronal, Distal penile
  • MIDPENILE
    • Midshaft
  • PROXIMAL
    • Proximal penile, Penoscrotal, Scrotal, Perineal
assosiation with other defects
ASSOSIATION WITH OTHER DEFECTS
  • Renal agenesis, dysplasia, reflux
  • Prostatic utricle
  • Hernia : 9%
  • Cryptorchidism : 9%
  • Father : 9%
  • Siblings : 14%
parts of hypospadias
PARTS OF HYPOSPADIAS
  • Meatus … usually non-stenotic
  • Stenosis more common in distal hypospadias
  • Megalomeatus intact prepuce
slide9
SKIN…..
  • Ventral defect & dorsal hood
  • Urethral delta
  • Hood of monk….Cobra eyes
  • Defects of spongiosum
  • Defects of cavernosa
  • Defective urethral plate
curvature
CURVATURE
  • Skin attachments
  • Bucks defect
  • Urethral plate
  • Cavernosa defects
  • Problems of unhealthy urethra
chordee without hypospadias
CHORDEE WITHOUT HYPOSPADIAS
  • Primary penile curvature
  • Types
    • Without defects (2/3)
    • With defects (1/3)
  • Penile torsion
  • Deviation to left
  • Concealed hypospadias
devine horton classification
DEVINE HORTON CLASSIFICATION
  • TYPE I :
    • SPONGIOSUM DEFECT
  • TYPE II :
    • BUCKS & DARTOS DEFECT
  • TYPE III :
    • DARTOS & SKIN DEFECT
hypospadias intersex
HYPOSPADIAS & INTERSEX
  • ? Form of androgen insufficiency
  • Mixed gonadal dysgenesis
  • Androgen insensitivity
  • Testosterone synthesis defects
  • 5 alpha reductase defects
features of repair
FEATURES OF REPAIR
  • Artificial erection ( Gittes & McLaughlin)
  • Meatal correction
  • Neourethral formation
  • Orthoplasty
  • Skin cover…. Neourethral cover
  • Dorsal prepuce : Tunica Vaginalis
  • Time of repair : 6months - 12months
correction of chordee after orthoplasty
CORRECTION OF CHORDEE AFTER ORTHOPLASTY
  • Nesbitt plication
  • T.A.P
  • Dermal graft
  • T.Vaginalis graft
  • Corporal resection
hcg before surgery
HCG BEFORE SURGERY
  • Increase in penile length
  • Meatal advancement by 5-20mm
  • Decrease in hypospadias
  • Decrease in chordee
  • Increased vascularity
  • Increased corporal thickness both proximal & distal
treatment options
TREATMENT OPTIONS
  • GLANDULAR & SUBCORONAL
    • MAGPI
    • GAP
    • MIP
  • DISTAL PENILE
    • MATHEIU
    • SNODGRASS
    • DEVINE HORTAN
    • MUSTARDEE
treatment options18
TREATMENT OPTIONS…
  • MIDPENILE
    • SNODGRASS
    • ONLAY ISLAND PREPUTIAL FLAP
    • KING
    • HODGSON II
  • PROXIMAL PENILE
    • TRANSVERSE PREPUTIAL FLAP
    • HODGSON I
    • HODGSON III
treatment options19
TREATMENT OPTIONS…
  • POSTERIOR URETHRA
    • TRANSVERSE PREPUTIAL FLAP
  • TWO STAGED
    • BUCCAL….TUBULAR….GLANS CHANNEL
    • BAYRS…
    • CECIL
    • SMITH
complications
COMPLICATIONS
  • BLEEDING & HEMATOMA
  • MEATAL STENOSIS
  • URETHROCUTANEOUS INFECTION
  • URETHRAL DIVERTICULA
  • RECURRENT CURVATURE / STRICTURE
  • BREAK DOWN