Peds

Hypospadias

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Hypospadias

  • Epidemiology
  1. Prevalence: 4.7 to 8 per male births
  1. Father with Hypospadias: 8% risk
  2. Brother with Hypospadias: 14% risk
  • Pathophysiology
  1. Congenital defect of Urethral meatus development
  2. Urethral folds incompletely fuse
  3. Ectopic Urethral meatus between glans and perineum
  • Associated conditions
  1. Undescended Testicle (10% association)
  2. Inguinal Hernia
  3. Hydrocele
  4. Chordee (ventral penile curvature)
  • Classification
  1. Anterior (Distal penis and glans): 50% of cases
  2. Middle (Midshaft of penis): 30% of cases
  3. Posterior (Scrotum, Perineum): 20% of cases
  • Management
  1. Avoid Circumcision (foreskin needed for repair)
  2. Surgical repair at 6 to 12 months of age
  • Complications of surgical repair
  1. Complications 5-15% (highest for posterior Hypospadias)
  2. Urethrocutaneous fistula or Urethral diverticulum
  3. Meatal stenosis
  4. Wound Infection, hematoma or dehiscence
  • Complications if not treated
  1. Urine stream deformity
  2. Sexual Dysfunction associated with curvature
  3. Infertility associated with proximal Urethral meatus
  • References
  1. Behrman (2000) Nelson Pediatrics, Saunders, p. 1645-7
  2. Borer (1999) Urol Clin North Am 26(1): 15-37 [PubMed]