HYPOSPADIAS

Introduction.
It is a birth defect found in boys
It occur in 1 to 350 male births The external meatus open not at the tip

of penis but located outside either on underside of penis or at perineum. Usually the inferior aspect of the prepuce is poorly developed ( hooded prepuce).

What cause the hypospadias??

Hypospadias result from incomplete

development of urethra. It sometimes inherited When we see a boy with hypospadias , there is a 20% chance of finding in another family member such father or brother. Other than inherited, the cause is usually not known.

Types of hypospadias :Glandular hypospadias ii) Coronal hypospadias iii) Penile and penoscrotal hypospadias iv) Perineal hypospadias
i)

i)

Glandular hypospadias - Most common type - The normal site of the external meatus is marked by a blind pit and it connects by a channel to the ectopic opening on the underside of the glans ii) Coronal hypospdias - The meatus is placed at the junction of the glans and the body of the penis iii) Penile and penoscrotal hypospadias - The opening is on the underside of the penile shaft. iv) Perineal hypospadias - Most severe abnormality - The scrotum is split and the urethra opens between its two halves. - There may be testicular maldescent which make it difficult to determine sex of the child.

- The more severe varieties of hypospadias represent an absence of the urethra and corpus spongiosum istal to the ectopic opening. -the absence structures are represented by a fibrous cord which deforms the penis in a downward direction (chordee). -The more distant the opening from its normal position, the more pronounced the bowing.

Picture 1. Proximal shaft hypospadias is shown. Note the deficient ventral foreskin, blind urethral pit at the glanular level, and lighter pigmented urethral plate extending to the true meatus at the proximal shaft level.

Penoscrotal hypospadias is shown. Note the associated ventral chordee and true urethral meatus located at the scrotal level.

Hypospadias. Severe penile chordee is shown. Note the extreme ventral curvature of the penile shaft.

Treatment..
Glandular hypospadias not need treatment unless

the meatus is stenosed. Most case a meatotomy is performed. Surgical correction is often undertaken before 2 years of age. The aims of surgery are to produce:I) A terminal urethral / meatus so that the boy can stand to micturate ii) A straight erection iii) A penis that looks normal.

Hypospadias. A pedicled preputial island flap is shown. This hairless skin flap will be rotated on its vasculare pedicle to the ventrum of the penis for repair of the urethra.

A urethrocutaneous fistula has appeared after hypospadias repair. Note one stream from true urethral meatus, and second stream through more proximal fistula.