Hypospadias

Deepak K Thakur
MS, MCh(Urology)
 Contents

• Introduction
• Embryology
• Risk Factors
• Classification
• Presentation
• Evaluation
• Treatment
 Introduction

• An abnormality of anterior urethral and penile

development in which the urethral opening is
ectopically located on the ventral aspect of the penis
proximal to the tip of the glans penis

• The urethral opening may be located as far down as in

the scrotum or perineum

• The penis is more likely to have associated ventral

shortening and curvature, called chordee, with more
proximal urethral defects
Embryology
 Embryology

• The external genital structures are identical in males and

females until 8 weeks' gestation; the genitals develop a
masculine phenotype in males primarily under the
influence of testosterone
• Classic theory:
– the urethral folds coalesce in the midline from base to tip,
forming a tubularized penile urethra and median scrotal raphe

– the anterior or glanular urethra develop with an ectodermal

core forming at the tip of the glans penis, which canalizes to
join with the more proximal urethra at the level of the corona
Embryology
 Risk Factors

• Genetic: polygenic inheritence- prevalence of

hypospadias in male children of fathers with
hypospadias has been reported as 8%, and 14% of
brothers of children with hypospadias are also affected

• Endocrine: decrease in available androgen or an inability

to use available androgen

• Environmental: Estrogens have been implicated in

abnormal penile development
Classification
 Presentation

• Prevalence: 1 in 300 males

• Approximately 90% of hypospadias cases are
isolated penile defects & rest are syndromic
• Typically preputial development is asymmetrical,
with a dorsal “hood” and ventral deficiency
• Others: downward glans tilt, deviation of the median
penile raphe, ventral curvature (VC), scrotal
encroachment onto the penile shaft
• Syndromic manifestations
 Evaluation

• Clinical
• Preoperative
• Syndromic
 Treatment

• Always surgical
• Age for Surgery: healthy full-term babies 3 months
of age or older
• Preoperative testosterone: considered in proximal
hypospadias
• Key steps:
– Correction of chordee
– Reconstruction of urethra
Treatment
Treatment
 Complications

• Bleeding
• Infection
• Glans dehiscence
• Urethrocutaneous fistula
• Urethral diverticulum
• Neomeatal stenosis