Updated: 3/3/2021

Hypospadias

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Snapshot
  • A child is born with a urethral opening located between the tip of the glans penis and the base scrotum.
Introduction
  • Abnormality of anterior urethral and penile development
  • Caused by congenital defect during development of the urethra
  • Urethral opening is ectopically located on the ventral side of the penis proximal to the tip of the glans penis
  • Urethral opening may be located in the scrotum or perineum
  • Position of the urethral meatus defines the type of hypospadia
  • Penis is more likely to have associated ventral shortening and curvature with more proximal defects
  • May be associated with family history of the disorder or infertility treatment (IVF)
Presentation
  • Symptoms
    • urination follows path of malpositioned urethral meatus
  • Physical exam
    • meatal location between tip of the glans and perineum
    • glans configuration may be splayed open in distal cases
    • skin coverage deficits must be noted
    • chordee may be appreciated resulting in abnormal curvature of the penis
Evaluation
  • Diagnosis is based on clinical observation alone
  • Family history
    • familial transmission may be identified
    • infertilty treatment should also be documented
      • IVF has been associated with a higher incidence of hypospadias
Differential
  •  Ambiguous genitalia, genital anomalies, error in circumcision
Treatment
  • Medical management
    • none
  • Surgical intervention
    • surgical repair
      • indicated in cases proximal (i.e. not adjacent to) from the glands penis
      • may not be indicated in less severe cases
      • multiple surgical approaches and methodology exist in the literature
      • usually performed before 1 year of age
Prognosis, Prevention, and Complications
  • Prognosis
    • ranges widely depending on location and severity of anatomic abnormality
    • surgical outcomes range, but as surgical technique and microsurgery improves, future prognosis is expected to increase significantly
  • Prevention
    • none
  • Complications
    • post-surgical complications, meatal stenosis, urethral strictures/diverticula, recurrent urinary tract infections, permanent phallic malformation

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