1. Hypospadias

2. Dorsal hooded foreskin
chordee
abnormal ventral meatus
scrotum
Hypospadias is a complex of an abnormal ventral meatus, chordee, and a dorsal hooded foreskin. Usually isolated, it can be part of the DSD spectrum.

3. Incidence: one in 300 live-births (but wide variation from 1 in 110 to 1 in 1,250)
Rising incidence
Associating with inguinal hernia and hydrocele (~10%), undescended testes (~8%)

4. Embryology
The development of male urethra takes place between the 8th and the 15th week of gestation under the influence of testosterone.
Etiology
Multifactorial involving genetic, endocrine, and environmental factors.

5. Genetic Factors Inheritance is unknown.The following facts:
Monozygotic twins – eightfold increase in the incidence of hypospadias
family history – 8% of fathers and 14% of brothers

6. Environmental Factors
Endocrine Factors
Deficient androgenic stimulation
Increased maternal progesterone exposure
Environmental Factors
↑Incidence of hypospadias and one hypothesis suggests that there is increased maternal exposure to estrogenic substances (contained in pesticides, milk, plastic linings of metal cans, and pharmaceuticals).

7. Clinical Features Classification
Distal (glanular, coronal, and subcoronal) (50%)
Middle (distal penile, midshaft, and proximal penile) (30%)
Proximal (penoscrotal, scrotal, and perineal) (20%)

8. Surgery
Principles
The goal of surgery is to create a cosmetically acceptable penis, which allows normal voiding with a forward stream and normal vaginal penetration.

9. Meatoplasty and glanuloplasty Skin coverage
Preoperative
completing the repair of hypospadias before 18 months of age (minimizes psychological impact of genital surgery).
Hormone manipulation
correction of chordee
Urethroplasty
Meatoplasty and glanuloplasty
Skin coverage

10. Postoperative
Early complications
bleeding, hematoma, infection, and breakdown of repair.
Long-Term Outcome
persistent chordee, meatal stenosis, urethrocutaneous fistula, urethral stricture, and urethral diverticulum. The incidence is highly variable though.

11. Thank you!