II. Epidemiology
- Incidence: 1 in 150 per male births
III. Predisposing factors: Family History
- Father with Hypospadias: 8% risk
- Brother with Hypospadias: 14% risk
IV. Pathophysiology
V. Associated Conditions
- Undescended Testicle (10% association)
- Inguinal Hernia
- Hydrocele
- Chordee (ventral penile curvature)
VI. Classification
- Anterior (Distal penis and glans): 50% of cases
- Middle (Midshaft of penis): 30% of cases
- Posterior (Scrotum, Perineum): 20% of cases
VII. Management
- Avoid Circumcision (foreskin needed for repair)
- Pediatric urology referral at age 3 to 4 months
- Surgical repair at 6 to 12 months of age
- Distal Hypospadias (most common)
- Typically repaired in a single surgery (curvature repaired at same time)
- Urethral catheter is typically in place for 1 week following surgery
- Few complications
- Proximal Hypospadias
- Evaluate for disorder of Sexual Development if Undescended Testicle also present
- Often requires 2 procedures for repair (esp. if severe curvature)
- Second surgery if needed is performed at 6 months
- Uses foreskin for repair graft (if second procedure needed)
- Distal Hypospadias (most common)
VIII. Complications: Surgical Repair
- Complications 5-15% (highest for posterior Hypospadias)
- Urethrocutaneous fistula or Urethral Diverticulum
- Meatal stenosis
- Wound Infection, Hematoma or dehiscence
IX. Complications: Utreated
- Urine stream deformity
- Sexual Dysfunction associated with curvature
- Infertility associated with proximal Urethral meatus
X. References
- Behrman (2000) Nelson Pediatrics, Saunders, p. 1645-7
- Granberg (2024) Mayo Clinic Pediatric Days, lecture attended 1/18/2024
- Borer (1999) Urol Clin North Am 26(1): 15-37 [PubMed]