HYPOSPADIAS

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HYPOSPADIAS

• Dr.GOVINDRAJAN
• Department of Urology and Renal Transplantation
• SRMC RI

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NORMAL PENILE ANATOMY

• 2 Corpora Cavernosa, Corpus Spongiosum
• Enclosed In A Fascial Sheath- T.Albuginea
• Bucks Fascia, Thick Fibrous Envelope
• Connective Tissue, Dartos Fascia

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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

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EMBRYOLOGY

• Cloacal membrane, genital tubercle, labioscrotal
  swellings
• Androgen stimulationphallus elongation
• 3 phases of urethral formation
• Posterior urethra formation
• Anterior urethra formation
• Glandular segment formation
• Prepuce formation

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CLASSIFICATION

• Smith ..
• Able .. I , II, III degree
• Browne .. Coronal - distal penile, proximal
  penile, penoscrotal, scrotal penile
• Basrat .. (post chordee release)

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CLASSIFICATION (LOCATION)

• DISTAL
• Glandular, Coronal, Distal penile
• MIDPENILE
• Midshaft
• PROXIMAL
• Proximal penile, Penoscrotal, Scrotal, Perineal

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ASSOSIATION WITH OTHER DEFECTS

• Renal agenesis, dysplasia, reflux
• Prostatic utricle
• Hernia 9
• Cryptorchidism 9
• Father 9
• Siblings 14

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PARTS OF HYPOSPADIAS

• Meatus usually non-stenotic
• Stenosis more common in distal hypospadias
• Megalomeatus intact prepuce

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SKIN..

• Ventral defect dorsal hood
• Urethral delta
• Hood of monk.Cobra eyes
• Defects of spongiosum
• Defects of cavernosa
• Defective urethral plate

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CURVATURE

• Skin attachments
• Bucks defect
• Urethral plate
• Cavernosa defects
• Problems of unhealthy urethra

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CHORDEE WITHOUT HYPOSPADIAS

• Primary penile curvature
• Types
• Without defects (2/3)
• With defects (1/3)
• Penile torsion
• Deviation to left
• Concealed hypospadias

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DEVINE HORTON CLASSIFICATION

• TYPE I
• SPONGIOSUM DEFECT
• TYPE II
• BUCKS DARTOS DEFECT
• TYPE III
• DARTOS SKIN DEFECT

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HYPOSPADIAS INTERSEX

• ? Form of androgen insufficiency
• Mixed gonadal dysgenesis
• Androgen insensitivity
• Testosterone synthesis defects
• 5 alpha reductase defects

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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

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CORRECTION OF CHORDEE AFTER ORTHOPLASTY

• Nesbitt plication
• T.A.P
• Dermal graft
• T.Vaginalis graft
• Corporal resection

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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

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TREATMENT OPTIONS

• GLANDULAR SUBCORONAL
• MAGPI
• GAP
• MIP
• DISTAL PENILE
• MATHEIU
• SNODGRASS
• DEVINE HORTAN
• MUSTARDEE

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TREATMENT OPTIONS

• MIDPENILE
• SNODGRASS
• ONLAY ISLAND PREPUTIAL FLAP
• KING
• HODGSON II
• PROXIMAL PENILE
• TRANSVERSE PREPUTIAL FLAP
• HODGSON I
• HODGSON III

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TREATMENT OPTIONS

• POSTERIOR URETHRA
• TRANSVERSE PREPUTIAL FLAP
• TWO STAGED
• BUCCAL.TUBULAR.GLANS CHANNEL
• BAYRS
• CECIL
• SMITH

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COMPLICATIONS

• BLEEDING HEMATOMA
• MEATAL STENOSIS
• URETHROCUTANEOUS INFECTION
• URETHRAL DIVERTICULA
• RECURRENT CURVATURE / STRICTURE
• BREAK DOWN