Hypospadias Prepared by : Sabah Salim Under supervision of : Dr. Qadir Mohemed 1 in every 250 male Causes Due to a wide range of known and unknown endocrine, genetic, and environmental factors. however, the specific etiology of hypospadias cannot be determined. Risk Factor Family history Genetics Maternal age over 35 Exposure to certain substances during pregnancy ***further studies are needed C/F  Rx Some forms of hypospadias are very minor and do not require surgery. Surgical (Urethroplasty , Repair) Hypospadias repair Done between 6mo-2year should not be circumcised at birth ? Mild defects repaired in 1 procedure. Severe defects need 2 or more procedures. Procedure Anastomotic urethroplasty. Buccal mucosal onlay graft Scrotal or penile flap (graft) Johansen's urethroplasty. Surgery is not needed if the condition does not affect normal urination while standing, sexual function, or the deposit of semen. Anastomotic urethroplasty. The success rate is above 95%, and is considered the "gold standard" of surgical repair options. It is used when strictures are less than 2 cm in length, however, some surgeons have had success with defects approaching 3 cm in length.  Bovie knife Prevent damage to nerves One stage And Two Stage Surgery Complications A hole that leaks urine (fistula) Large blood clot (hematoma) Scarring or narrowing of the repaired urethra Infection If the repair is not done, problems may occur later on such as: Difficulty controlling and directing urine stream A curve during erection Decreased fertility Embarrassment about appearance. …Thank You

1. Hypospadias
Prepared by : Sabah Salim
Under supervision of : Dr. Qadir Mohemed

2. Embryological Information
Fertilization --- Zygote --- Morula --- Blastula--- Gastrulation ---- Trilaminar
Ecto. Meso. And Endoderm.
Masculinization :
Androgen-driven process, (hCG)
Leydig cells , testes produce testosterone.
active (DHT) by the enzyme 5-α reductase.
To develop genitalia,
(DHT) must bind to androgen
receptors located in the genital tissues.

3. Testosterone effects :
1- Increase distance between anus and genital structures.
2- Elongation of genital tubercle, which will become the penile shaft and
glans.
3- Genital swellings(labioscrotal folds) fuses forming the scrotum.
4- Urethral folds have inner (endodermal) and outer (ectodermal) edges:
A- Fusion of the endodermal folds to form a tubular penile urethra.
B- Fusion of the endodermal edges creates an epithelial seam.
C- Ectodermal edges then fuse over the urethra to fashion the penile shaft
skin.

5. 1 in every 250 male
Is Congenital defect of the urethra where the urinary opening is
not at the usual location on the head of the penis.
What’s Hypospadias ?
So…..

6. Mild
Moderate
Severe

7. More severe forms of hypospadias are associated with penile curvature (chordee)
Chordee : is a condition in which the head of the penis curves downward or upward

8. Causes
• Due to a wide range of known and
unknown endocrine, genetic, and
environmental factors.
however, the specific etiology of
hypospadias cannot be determined.

9. Risk Factor
• Family history
• Genetics
• Maternal age over 35
• Exposure to certain substances during
pregnancy
***further studies are needed

10. C/F
Location
Chordee
Hooded appearance
Urination

11. Rx
• Some forms of hypospadias are very
minor and do not require surgery.
• Surgical (Urethroplasty , Repair)

12. Hypospadias repair
• Done between 6mo-2year
• should not be circumcised at birth ?
• Mild defects repaired in 1 procedure.
• Severe defects need 2 or more
procedures.

13. Procedure
• Anastomotic urethroplasty.
• Buccal mucosal onlay graft
• Scrotal or penile flap (graft)
• Johansen's urethroplasty.

14. • Surgery is not needed if the condition
does not affect normal urination while
standing, sexual function, or the deposit
of semen.

15. Anastomotic urethroplasty.
• The success rate is above 95%, and is
considered the "gold standard" of surgical
repair options. It is used when strictures are
less than 2 cm in length, however, some
surgeons have had success with defects
approaching 3 cm in length.

16. • Bovie knife
• Prevent damage to nerves
• One stage And Two Stage Surgery

17. Complications
• A hole that leaks urine (fistula)
• Large blood clot (hematoma)
• Scarring or narrowing of the repaired
urethra
• Infection

18. If the repair is not done, problems may
occur later on such as:
• Difficulty controlling and directing urine
stream
• A curve during erection
• Decreased fertility
• Embarrassment about appearance.

20. …Thank You