Hypospadia

Rengga Pradipta
1201-1211-0146

Preface
Hypospadias refers to incomplete
urethral development that results in a
meatus located anywhere from the
proximal glans to the perineum.
Short urethra
Urethral meatus is formed along the
shaft (shaft) of the penis, from the
glans to the rectum, even in the
perineum.

ETIOLOGY

Genetic
Estrogen and androgen deficiency
-Reduced androgen hormone decreased
production dehidrotestosterone (DHT) which is
influenced by 5 reductase, this hormone
plays a role in the formation of phallus and
urethra
-Estrogen is influenced in male external genitalia
formation
Industrial waste Endocrin discrupting
chemicals The anti-androgenic properties :
polychlorobiphenyls, dioxins, furans,
peptisidaorganochlorin, alkilphenol
polyethoxsylates
andphtalites

 Hypospadias is a congenital defect that

occurs during embryological development
of the urethra
During phallus development, the urethra
opening extends from the base to the
corona
Urethral folds on the center line of the
base to the tip, forming the penile urethra
and scrotum raphe media, which will
become the posterior urethra and media

 Hypospadias occurs due to

incomplete fold fusion of the urethra
and there is an abnormal urethral
opening along the inferior surface of
the penis
If urethra unification fails, it will be
found a wide gap extends along the
penis and scrotum

Hhypospadias classification based on

location of the meatus

 Browne 1936 split

hypospadia into three parts are clinically
meaningful to know the length of the urethra
and to know how much the level of difficulty
in the management of surgical
reconstruction:
Degree I: OUE Lies on the surface of the
penis and corona glandis ventralglans.
Grade II: OUE Located on the surface of the
penis ventralkorpus.
Grade III: Located on the surface or
perineum ventralskrotum

Classification glans configuration

A. Cleft glans
B. Incomplete cleft
glans
C. Flat Glans

symptoms
difficulty in regulating the flow of urine
(when urinating).
causing the patient should be in a
sitting position when micturition
sexual disturbances

PE
(OUE) was not in the end of the
glands penis
Preputium piled in the back.
if the penis had curvature (curved)
when erect, it can be concluded the
chordae, The fibrous tissue that
stretches up to the glans penis.

Management
Straighten a complete penis
Putting meatus at the tip of the
glans.
Forming a symmetrical glans and
diameter of the urethra.
Perform a complete skin closure.
Correct anatomic abnormalities

 Reconstruction phallus to do before the

age of learning ( 1.5 months - 2
years)
Chordectomi:
off chordae to improve function and
improve appearanceof penis
Urethroplasty:
make The urethra Osteum externa to
tip of penis gland so that urine and
semen can beam straight ahead.

Things to consider in achieving

successful surgical opration
The ideal age for repair hypospadia the age of
1.5 months - 2 years (up to age not attending
school) due consideration to the child's
psychological factors so that the stage
repair hypospadiabeen reached before school.
Type of hypospadia and the size of the penis
and the presence or absence chorde
Types of hypospadia and large of the penis
very influential on-stage and operation
technique. The smaller phallus and proximal
type of hypospadia difficult technical
operations.

 Duplay method : To reconstruct

Hypospadia
middle type
Ombredane methode :to reconstruct
Hypospadia coronal and distal type
Nove-josserand : To reconstruct various
types
Of Hypospadia

Complication

Bleeding
Infection
Fistule
Stricture
Diverticulitis
Retrusive Meatus
persistent chordae
Complications of Multiple Recurrences
Reproductive / Sex

 Thank you