1. Department of Urology and Renal Transplantation
HYPOSPADIAS
Dr.GOVINDRAJAN
Department of Urology and Renal Transplantation
SRMC & RI

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

3. 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

4. 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

5. CLASSIFICATION Smith …….. Able …….. I , II, III degree
Browne …….. Coronal - distal penile, proximal penile, penoscrotal, scrotal penile
Basrat …….. (post chordee release)

6. CLASSIFICATION (LOCATION)
DISTAL
Glandular, Coronal, Distal penile
MIDPENILE
Midshaft
PROXIMAL
Proximal penile, Penoscrotal, Scrotal, Perineal

7. ASSOSIATION WITH OTHER DEFECTS
Renal agenesis, dysplasia, reflux
Prostatic utricle
Hernia : 9%
Cryptorchidism : 9%
Father : 9%
Siblings : 14%

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

9. SKIN….. Ventral defect & dorsal hood Urethral delta
Hood of monk….Cobra eyes
Defects of spongiosum
Defects of cavernosa
Defective urethral plate

10. CURVATURE Skin attachments Bucks defect Urethral plate
Cavernosa defects
Problems of unhealthy urethra

11. CHORDEE WITHOUT HYPOSPADIAS
Primary penile curvature
Types
Without defects (2/3)
With defects (1/3)
Penile torsion
Deviation to left
Concealed hypospadias

12. DEVINE HORTON CLASSIFICATION
TYPE I :
SPONGIOSUM DEFECT
TYPE II :
BUCKS & DARTOS DEFECT
TYPE III :
DARTOS & SKIN DEFECT

13. HYPOSPADIAS & INTERSEX
? Form of androgen insufficiency
Mixed gonadal dysgenesis
Androgen insensitivity
Testosterone synthesis defects
5 alpha reductase defects

14. 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

15. CORRECTION OF CHORDEE AFTER ORTHOPLASTY
Nesbitt plication
T.A.P
Dermal graft
T.Vaginalis graft
Corporal resection

16. 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

17. TREATMENT OPTIONS GLANDULAR & SUBCORONAL DISTAL PENILE MAGPI GAP MIP
MATHEIU
SNODGRASS
DEVINE HORTAN
MUSTARDEE

18. TREATMENT OPTIONS… MIDPENILE PROXIMAL PENILE SNODGRASS
ONLAY ISLAND PREPUTIAL FLAP
KING
HODGSON II
PROXIMAL PENILE
TRANSVERSE PREPUTIAL FLAP
HODGSON I
HODGSON III

19. TREATMENT OPTIONS… POSTERIOR URETHRA TWO STAGED
TRANSVERSE PREPUTIAL FLAP
TWO STAGED
BUCCAL….TUBULAR….GLANS CHANNEL
BAYRS…
CECIL
SMITH

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