HYPOSPADIAS

BY: DR ASHRAF MC
POST GRADUTE STUDENT
 DEFINITION – IT IS AN ABNORMAL URETHRAL
OPENING ANY WHERE ALONG VENTRAL ASPECT
OF GLANS, SHAFT OF PENIS OR INTO THE
PERINEUM IN A BOY WITH OR WITHOUT A
CHORDEE
 CHORDEE – THE ABNORMAL VENTRAL
CURVATURE OF PENIS CAUSED BY DEFICIENCY OF
NORMAL STRUCTURES ON THE VENTRAM OF
PENIS, CONTRIBUTING FACTORS INCLUDE
*SKIN DEFICIENCY
*DARTOS FASCIA FIBROSIS
*TRUE FIBROUS CHORDEE WITH
TETHERING OF *VENTRAL SHAFT OR CORPORA
CAVERNOSA `DISPROPORTION
CLASSIFICATION
 INCIDENCE – 1 IN 300 LIVE BIRTHS

 INCREASED RISK IN MATERNAL ESTROGEN AND

PROGESTERONE USE DURING PREGNANCY

 PENOSCROTAL AND PENILE HYPOSPADIAS MUST

BE DISTINGUISHED INTERSEX DISORDER >>
KARYOTYPING
EMBRYOLOGY
 EMBRYOLOGY
 URETHRAL TUBULARISATION IS PROXIMO-DISTAL

 TESTOSTERONE, DIHYDRO TESTOSTERONE AND

INCOMPLETE VIRILISATION

 CHORDEE

 VENTRAL PREPUCIAL DEFECT WITH DORSAL

HOOD - THE PREPUCIAL HOOD.
 ASSOCIATED ANOMALIES
 UNDESCENDED TESTIS

 INGUINAL HERNIA

 UPPER URINARY TRACT ANOMALIES

 INTER SEX DISORDERS- D/D
 ADRENOGENITAL SYNDROME

 MIXED GONADAL DYEGENESIS

 INCOMPLETE MALE PSEUDOHERMOPHRODITISM I

>> REIFENSTEIN SYNDROME

 INCOMPLETE MALE PSEUDOHERMOPHRODITISM II

>>

 TRUE HERMOPHRODITISM
 THE TRETMENT OF HYPOSPADIS IS ONLY
SURGICAL

 SURGICAL TRETMENT IS ALONG EMBRYOLOGICAL

LINES TO COMPLETE THE PROCESS OF
VIRILISATION

 AIMS OF SURGICAL TREATMENT INCLUDE

# CORRECT COSMETIC DEFECT
# PRODUCE MAETUS SITUTED AT THE TIP OF THE
GLANS
# PRODUCE FORWARD PROJECTED URINARY
STREAM
# ALLOW ERECTION WITHOUT VENTRAL
CURVATURE
 HISTORY OF SURGICAL
PROCEDURES
 I ST SURGERY HELIODORUS AND ANTYLLUS 100-
200 A D – AMPUTATION OF SHAFT DISTAL TO
EXISTING MAETUS

 DIEFFENBACH – 1838 PIERCING THE GLANS WITH

CANULA TILL URETHRAL MEATUS ALLOWING FOR
EPITHELISATION

 BOUISSON 1861 – TRANSVERSE INCISION AT

GRTEST CURVATURE, SCROTAL TISSUE
RECONTRUCT URETHRA
 THEIRSH 1869 – BUTTON HOLE FLAP FOR
RESURFACING OF THE VENTRUM WITH PREPUCE

 HOOK 1896 VASCULARISED PREPUCIL FLAP FOR

URETHROPLASTY

 BEVAN 1917 – URETHRAL MEATUS BASED FLAPS

CHANNELED THROUGH GLANS FOR DISTAL
REPAIR

 GITTES MC LAUGHLIN 1974 – THE TECHNIQUE OF

ARTIFICIAL ERECTION
• BASKIN AND DUCKETT 1994 – TUNICA ALBUGENIA
PLICATION FOR ORTHOPLASTY.
 AGE FOR REPAIR IS LESS THAN 2 YEARS
 “ IT IS THE INALIENABLE RIGHT OF EVERY BOY
TO BE A POINTER INSTEAD OF A SITTER BY THE
TIME HE STARTS SCHOOL AND TO WRITE HIS
NAME LEGIBLY IN THE SNOW” – CULP AND
McROBERT 1968

 ONE STAGE / TWO STAGE / MULTI STAGE

REPAIRS – ONE STEGE REPAIR WHENEVER
FEASIBLE IS IDEAL

 ROLE OF TESTOSTERONE STIMULATION

 THE BASIC STEPS OF HYPOSPADIAS REPAIR
INCLUDE
MEATOPLASTY AND GLANULOPLASTY
ORTHOPLASTY- CHORDEE RELEASE
URETHROPLASTY
SKIN COVER
SCROTOPLASTY

 OVER 200 ORIGINAL METHODS OF URETHRAL

RECONSTRUCTION HAVE BEEN DESCRIBED AND
MANY MODIFICATIONS AND THE MODIFICATION OF
MODIFICATIONS ARE CONTINUINNG
 TECHNIQUES FOR ANTERIOR
HYPOSPADIAS
 MAGPI PROCEDURE – MAETAL ADVANCEMENT
AND GLANULOPLASTY &
ARAP MODIFICATION
 URETHRAL MOBILISATION
 MATHIEU PROCEDURE – PARAMEATAL BASED
FLAP
 MEGAMEATUS INTACT PREPUCE – PYRAMID
PROCEDURE
 ONLAY ISLAND FLAP FOR ANTERIOR MEATUS
 OTHER TECHNIQUES
MAGPI PROCEDURE
MATHIEU PROCEDURE
BARCAT REDMAN PROCEDURE
PYRAMID PROCEDURE
ONLAY ISLAND FLAP
 TECHNIQUES FOR MIDDLE AND
POSTERIOR HYPOSPADIS
 ASOPA PROCEDURE
 TRANSVERSE PREPUCIAL ISLAND FLAP AND
GLANS CHANNEL
 BLADDER MUCOSAL GRAFTS – BIMG AND BUCCAL
MUCOSAL GRAFTS- BUMG FOR COMPLEX
HYPOSPADIAS
ASOPA PROCEDURE
TRANSVERSE PREPUCIAL
ISLAND FLAP
BUCCAL MUCOSAL GRAFT
SCROTOPLASTY
 RECENT PROCEDURES
 KOYANAGI REPAIR

 TUNICA VAGINALIS BLANKET WRAP

 LASER WELDING / SUTURELESS URETHROPLASTY

 COMPLICATIONS OF SX
 WOUND INFECTION
 EDEMA / HEMATOMA COLLECTION
 URETHROCUTANEOUS FISTULAS
 RESIDUAL CHORDEE
 DIVERTICULUM
 STRICTURE
 MEATAL STENOSIS
 BALANITIS XEROTICA OBLITERANS
PSYCHOSOCIAL SUPPORT
FOLLOW UP
CONCLUSION