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
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
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

CLASSIFICATION
Smith
Able

..
.. I , II, III degree

Browne .. Coronal - distal penile, proximal penile, penoscrotal, scrotal penile Basrat .. (post chordee release)

CLASSIFICATION (LOCATION)
DISTAL
Glandular, Coronal, Distal penile

MIDPENILE

Midshaft

PROXIMAL
Proximal penile, Penoscrotal, Scrotal, Perineal

ASSOSIATION WITH OTHER DEFECTS

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

PARTS OF HYPOSPADIAS
Meatus usually non-stenotic Stenosis more common in distal hypospadias Megalomeatus intact prepuce

SKIN..
Ventral defect & dorsal hood
Urethral delta

Hood of monk.Cobra eyes

Defects of spongiosum Defects of cavernosa Defective urethral plate

CURVATURE
Skin attachments Bucks defect

Urethral plate
Cavernosa defects Problems of unhealthy urethra

CHORDEE WITHOUT HYPOSPADIAS

Primary penile curvature
Types Without defects With defects Penile torsion Deviation to left Concealed hypospadias

(2/3) (1/3)

DEVINE HORTON CLASSIFICATION

TYPE I :
SPONGIOSUM DEFECT

TYPE II :
BUCKS & DARTOS DEFECT

TYPE III :
DARTOS & SKIN DEFECT

HYPOSPADIAS & INTERSEX

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

FEATURES OF REPAIR
Artificial erection ( Gittes & McLaughlin)
Meatal correction Neourethral formation Orthoplasty Skin cover. Dorsal prepuce Time of repair Neourethral cover : Tunica Vaginalis : 6months - 12months

CORRECTION OF CHORDEE AFTER ORTHOPLASTY

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

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