Hypospadias

Glandular REF: Bailey and love 24^th ed p. 1389

Hypospadias is most common congenital malformation of urethra

Types of hypospadias

• Glandular (50-70%)
• Penile
• Subcoronal
• Penoscrotal
• Scrotal
• Perineal

Ans. is ‘b’ i.e. Glandular

• Hypospadias is a condition in which the urethral meatus opens on the underside of penis or the perineum (i.e. ventral surface of penis) proximal to the tip of the glans penis.
• There are several types of hypospadias acccccording to location

Ans. is ‘b’ i.e., 6 – 10 months 

“The best time for surgery for hypospadias is between 6-12 months of age” – Cambell’s Urology

Ans is ‘d’ i.e., Cryptorchidism 

• Cambell’s Urology defines hypospadias as an association of 3 anatomic and developmental anomalies of penis.

1)       An abnormal ventral opening of the urethral meatus

2)       An abnormal Ventral curvature of the penis (chordee)

3)       A abnormal distribution of foreskin with a ‘hood’ present dorsally and deficient foreskin ventrally (hooded prepuce)

Glandular variety- It may not require surgical correction, because it does not cause the urinary stream to be misdirected or the penis to be curved during an erection (This is the mildest and most common form)

• Remember that Cryptorchidism is not a feature of hypospadias. But it may be seen associated with hypospadias in 8-9% of cases [Ref: Cambell’s Urology 8/e p2291, Smith’s Urology 17/e p631 (16/e p618)]

Answer is ‘b’ i.e. Dorsal chordee 

• Ventral chordee is seen in hypospadias
• Dorsal chordee is a feature of epispadias

Answer is ‘c’ i.e. Mental Retardation 

• Meatal stenosis may be associated with hypospadias and needs meatotomy for correction.
• Bifid scrotum may be seen in penoscrotal, scrotal & perinea! hypospadias.

Ans. is ‘a’ i.e. Meatal stenosis; ‘b’ i.e. Dorsal hood; ‘c’ i.e. Proximal opening of meatus 

Ans. is ‘a’ i.e., Chordee is reversed after 5 years 

Two-stage urethroplasty – When the child is 6 -12 months old, chordee is corrected by straightening the penis. This is called orthoplasty.
When the child is 5-6 years old, reconstruction of the urethra is done by using locally available skin either from the prepuce or from penile shaft. This is called urethroplasty. Hence, circumcision should not be done in hypospadias.
Glandular and Coronal varieties do not give major problems functionally. It can be left alone without treatment.

Ans. is ‘a’ i.e., Glandular 

Ans. is ‘b’ i.e., Less common 

Ans. is ‘c’ i.e., Karyotyping 

Ans. is ‘a’ i.e., Ectopia vesicae 

Chordee (ventral curvature of the penis) is often associated with hypospadias, especially more severe forms.

Failure of fusion of the urethral folds in hypospadias impedes this process, and a dorsal hooded prepuce results. 

A history of infertility and treatment should also be documented; in-vitro fertilization (IVF) has been associated with a higher incidence of hypospadias.

Associated with-
1. Hooded prepuce over dorsal aspect
2. Ventral Chordee
3. Flattened Glans penis
4. Microphallus
5. Ectopic Meatus
6. Meatal stenosis
Clinical features-
1. Anterior- abnormal stream
2. Posterior – secretion deposited ontside vagina
Painful erection
Infertility

Ans. A: Glandular

Glandular hypospadias is common and does not usually require treatment

Distal or glandular: The most common form when opening is found near the head of the penis.

• Distal or glanular: most common form when opening is found near the head of the penis.

Hypospadias:

• The external meatus opens on the underside of the penis or the perineum, and the inferior aspect of the prepuce is poorly developed (hooded prepuce)
• Meatal stenosis occurs
• Bifid scrotum
• 6 – 10 months of age is the best time for surgery