HYPOSPADIAS DR TARIK ELDARAT MD

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

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 stimulation…phallus 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: 9% Cryptorchidism: 9% Father: 9% Siblings: 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 (2/3) With defects (1/3) Penile torsion Deviation to left Concealed hypospadias

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….Neourethral cover Dorsal prepuce: Tunica Vaginalis Time of repair: 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