Hypospadias for medical students

1. HYPOSPADIAS
……..THE FULL STORY
SAMEH SHEHATA

2. Hypospadias?
Hypospadius?

3.  DEFINITION
 Types
 Aetiology
 Aim of surgery
 Surgery
 Complications

4. Aetiology……..
 Is unclear & thought multifactorial.
 Undescended testis & inguinal hernias are
associated abnormalities
 Genetic - high familial incidence.
 ? decrease in foetal testosterone production
caused by external sources.

5. Embryology

9. Diagnosis……...
 Usually detected at birth
 May have :
 Difficulty with micturition
 Retention of urine & thin stream
 Altered voiding position
sit ~ penoscrotol
~ perianal
hold the penis upwards
~ midshaft
 Hooded prepuce - formed dorsally

10. Hypospadias…….
 Congenital defect
 Incidence is 1 in 300 live male births.
 Occurs during the third or fourth month of
gestation
 Urethral opening exits on the ventral side of
the penis.
 From the failure of the mid line urethral folds
to close.

11. Types of hypospadias (1)…...
 Coronal-
 Most common
Opening lies next to the groove
Varying depths on the ventrum of glans.
 Penile-
Opening lies between the base of penis &
subcoronal

12. components
 Urethral opening.
 Prepuce.
 Chordee.
 Associated anomalies.

17. Goals of surgery
 Straight penis.
 Terminal urethra.
 Free of complications .
 Cosmetic.

18. Steps of the operation
 Degloving.
 Urethroplasty.
 Covering the repair .
 Skin covering.

19. Degloving
 All cases even minor .
 Corrects chordee.

22. Urethroplasty
 300 techniques!!!

23. Urethroplasty
 Local : penile skin
 Flaps (vascular) : dorsal prepuce .
 Graft (free) :
 skin
 Bladder .
 Buccal
 Urethral plate.

24. Flaps : Duckett

25. Flaps : Duckett

26. Graft: buccal

27. Graft : bladder mucosa

28. Graft: Skin

29. Urethral plate
 Originally intended to
form urethra.
 Ideal histology and
vascularity .

30. TUBULARIZED INCISED PLATE
TIP repair Snodgrass

31. Snodgrass repair…….
 Technique

 dissection of the urethral plate
 tubularized over a urethral catheter
 Incised to give more width

33. Skin covering
 Dorsal prepuce.
 Penile shaft.

34. Urinary diversion
 Transurethral catheter
 1 -7 days
 Avoid urine contact till healing .
 Stent .

35. Dressing
Minimize
edema ,
hematoma.
Removed after
3 days

36. Dressing Types…….
 Main purpose of dressings are to -
 protect suture line
 minimise swelling
 immobilise penis

37. Complications
Minor
 Edema
 Hematoma
Moderate
 Fistula
 Stenosis
 Diverticulum.

38. complications
Severe ( unacceptable)
 Disruption
 Residual chordee

39. By this session we will have
explored……...
 Different types of hypospadias
 Cause and aetiology
 Treatment and types of surgery
 Types of dressings
 Postoperative care
 Follow up
 Complications