Hypospadias
Under supervision
Assist prof/ Hanaa Mabrouk
A.L/ Hadeer Hamdy
2022 - 2023
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Prepared by:
228 • Mohammed Wahba Abd-Elmordy Mohammed
229 • Mohammed Yasser Abd-Elaziz Newishy
230 • Mohammed Yasser Abd-Elwanes Zahra
231 • Mohammed Yousry Abd-Elgawwad Maraq
232 • Mahmoud Ahmed Abd-Eldayem Salman
233 • Mahmoud Ahmed Fahmy Elgammal
234 • Mahmoud Ashraf Ahmed Badawy Ali
235 • Mahmoud Elsayed Mahmoud Elsayed Allam
236 • Mahmoud Elmeselhy Mohammed Elmeselhy Eltish
237 • Mahmoud Badr Mohammed Mahrous Salem Ali
238 • Mahmoud Ramadan Mahmoud Elgibaly
239 • Mahmoud Samir Abd-Elaleem Elgamal
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Outlines
• Introduction
• Definition
• Pathophysiology
• Types
• Causes
• Signs and Symptoms
• Diagnosis
• Complications
• Surgical Management
• Preoperative and Postoperative Care
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Introduction
Hypospadias may be defined as a ventral penile
hypoplasia with some associated anomalies such as the
following: opening of the meatus below the tip of the
penis, ventral penile curvature (chordee) and a hooded
foreskin with excessive dorsal part. The incidence of
hypospadias in the Western countries has been in rise
tremendously and is approximately 1 to 150,300 male
births.
Definition
Hypospadias is a birth defect (congenital condition) in
which the opening of the urethra is on the underside of the
penis instead of at the tip.
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Pathophysiology
Hypospadias is a congenital defect that is thought to occur
during the embryologic development of the urethra,
between 8 and 20 weeks' gestation. The external genital
structures are identical in males and females until 8
weeks, after which time the genital structures develop a
masculine phenotype in males, primarily under the
influence of testosterone and its byproduct,
dihydrotestosterone. As the phallus grows, the open
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urethral groove extends from its base to the level of the
corona and opens in other places that are not normal.
Causes
1- Hypospadias is present at birth (congenital). As the
penis develops in a male fetus, certain hormones stimulate
the formation of the urethra and foreskin.
2- Hypospadias results when a malfunction occurs in the
action of these hormones, causing the urethra to develop
abnormally.
3- In most cases, the exact cause of hypospadias is
unknown. Sometimes, hypospadias is genetic, but
environment also may play a role.
Types of Hypospadias
- The type of hypospadias a boy has depends on the
location of the opening of the urethra:
1. Subcoronal: The opening of the urethra is located
somewhere near the head of the penis.
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2. Midshaft: The opening of the urethra is located along
the shaft of the penis.
3. Penoscrotal: The opening of the urethra is located
where the penis and scrotum meet.
Signs and Symptoms
1- Opening of the urethra at a location other than the tip
of the penis.
2- Chordee: Penis curves downward.
3- Undescended testicle: One of the testicles doesn’t fully
descend into the scrotum (in about 10% of cases).
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4- Undeveloped foreskin: The skin that covers the head of
the penis isn’t complete, so Babies with hypospadias
should not be circumcised.
5- Abnormal urination: Urine doesn’t spray in a straight
stream.
Diagnosis
- Healthcare providers usually diagnose this condition
when a baby is born.
- Checking for hypospadias is part of the routine newborn
examination after birth (physical Examination).
- It’s easy to notice the problem; the hole of the penis is in
the wrong place. Often, the foreskin is unformed, so the
tip of the penis is exposed.
- If the pediatrician detects hypospadias, they’ll refer you
to a pediatric urologist for treatment; Hypospadias repair
can correct the problem.
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Complications
1- Stricture Formation.
2- Urethral Fistula.
3- Severe Skin Edema.
4- Subcutaneous Hematoma.
5- Persistent Chordee.
6- Scrotal Abscess.
7- Bladder Calculus.
Surgical Management
Some forms of hypospadias are very minor and do not
require surgery. However, treatment usually involves
surgery to reposition the urethral opening and, if
necessary, straighten the shaft of the penis. Surgery is
usually done between the ages of 6 and 12 months.
The surgical management of hypospadias aims to achieve:
- A straight penis with a slit-shaped and adequate caliber
meatus at the apex of the glans.
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- A conical reconfigured glans.
- Either a circumcised appearance of the penis or if the
parents opt for preputial reconstruction, a foreskin that is
complete circumferentially and easily retractable.
- An acceptable cosmetic outcome judged objectively.
The surgeon will use a small piece of foreskin or tissue
from another site to create a tube that increases the length
of the urethra. Extending the length of the urethra will
allow it to open at the tip of the penis.
During surgery, the surgeon may place a catheter (tube) in
the urethra to make it hold its new shape. The catheter
may be sewn or fastened to the head of the penis to keep
it in place. It will be removed 1 to 2 weeks after surgery.
Most of the stitches used during surgery will dissolve on
their own and will not have to be removed.
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Preoperative Care
1- The week before your child’s surgery:
Tell your child’s surgeon about all the medicines your
child takes. He or she will tell you if you need to stop any
medicine before surgery, and when to stop. He or she will
tell you which medicines to give or not give your child on
the day of surgery.
Your child may need blood or urine tests, or a 13
ultrasound before his surgery. Talk to your child’s
surgeon about these or other tests he may need. Write
down the date, time, and location for each test.
2- The night before your child’s surgery:
You may be told not to give your child anything to eat or
drink after midnight.
3- The day of your child’s surgery:
You or a close family member will be asked to sign a
legal document called a consent form. It gives healthcare
providers permission to do the procedure or surgery on
your child. It also explains the problems that may happen,
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and your choices. Make sure all your questions are
answered before you sign this form.
An IV will be put into your child’s vein. He may get
medicine or liquids through the IV.
An anesthesiologist will talk to you and your child before
the surgery. Your child will need medicine to keep him
asleep during surgery. Tell healthcare providers if anyone
in your family has had a problem with anesthesia in the
past.
Postoperative Care
1. Monitor vital signs.
2. Catheter care should be given.
3. Put restraints so that child shouldn’t take out catheter or
other tubing.
4. Urine examination should be done to rule out any
infection.
5. Support and guidance of parents is very important.
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