This document summarizes information about hypospadias, a congenital malformation where the opening of the urethra is on the underside of the penis instead of at the tip. It discusses the presentation, causes, classification, associated anomalies, surgical repair techniques, and complications of hypospadias. The goal of surgery is to completely repair the penis by placing the urethral opening at the tip and achieving a symmetrical, conical glans with uniform caliber urethra and satisfactory cosmetic coverage.
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
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
The umbilicus is the remnant of the fetal maternal connection . In the developing fetus , the various component structures of the umbilical cord pass through the ventral abdominal wall . These comprise the umbilical vein which leads to the liver , paired umbilical arteries which arise from the iliac arteries as well as the urachus which passes to the bladder.
Spigelian Hernia: A Rare Hernia With Peculiar Anatomy. (Case Report And Revie...KETAN VAGHOLKAR
Background: Spigelian hernia best described as
spontaneous lateral ventral hernia is an extremely rare type of
hernia. The anatomical peculiarities and diagnostic challenges
need to be understood in order to surgically mange this hernia.
Introduction: Spigelian hernia occurs through a defect in the
spigelian fascia typically lying in the spigelian zone.
Case report: A case of a large incarcerated spigelian hernia
is presented to highlight the diagnostic and anatomical
peculiarities of this hernia.
Discussion: The anatomical basis of this hernia along with
clinical presentation, diagnostic modalities and treatment
options is discussed.
Conclusion: Clinical suspicion confirmed by imaging is
necessary for diagnosis. Surgery is the mainstay of treatment.
The esophageal hiatus is an elliptical opening in the diaphragmatic muscular portion. The crura of diaphragm originate from the anterior surface of the first four lumbar vertebrae on the right and L2–L3 on the left to insert anteriorly into the transverse ligament of the central portion of diaphragm.
Colonic incarceration in an adult umbilical hernia: case report and review of...KETAN VAGHOLKAR
Umbilical hernia is one of the commonest ventral hernias constituting ten percent of all hernias. It affects obese individuals and has a high recurrence rate if repaired by suture techniques. Incarceration of the colon in an umbilical hernia is quite rare. A case of colonic incarceration in an umbilical hernia is presented to highlight the diagnostic and technical challenges in managing such a hernia. Contrast enhanced computerized tomography is essential to ascertain the contents. Open surgery is the main stay of treatment especially in such rare cases. A combined tissue and mesh repair provides excellent results.
Sliding inguinal hernia continues to be the most challenging hernia to treat. Both diagnosis and treatment pose a
dilemma to the attending surgeon. Understanding the pathological anatomy of the sliding inguinal hernia is essential
for optimal choice of surgical procedure without causing damage to the involved viscera. A case of sliding inguinal
hernia is presented to highlight the diagnostic and technical challenges for repair of sliding hernia. Majority of sliding
hernias are diagnosed at the time of surgery. Sigmoid colon is a commonest content in a left sided sliding hernia.
Bevan’s technique is best suited to deal with the sac followed by Lichtenstein tension-free mesh repair.
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5. Hypospadias associated with maternal (gestational) treatment with progestins. (From Aarskog D: Maternal progestins as a possible cause of hypospadias. N Engl J Med 1979;300:75–78, with permission.)
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7. Classical (ectodermal ingrowth) and recently purported (endodermal differentiation) theories of distal glanular urethral development. (From Kurzrock EA, Baskin LS, Cunha GR: Ontogeny of the male urethra: Theory of endodermal differentiation. Differentiation 1999;64:115–122, with permission.)
8. Anatomically descriptive levels of hypospadias within the three major categories, based on the level of the meatus following orthoplasty.
9. Typical appearance of hypospadias. A , Dorsal “hood” foreskin (upper arrow) and distal glanular groove (lower arrow) . B , Ventral view of same patient showing paucity of foreskin and proximally placed meatus (arrow) .
10. Megameatus, intact prepuce (MIP) variant of hypospadias. A , Normal appearance of foreskin on lateral view. B , Sound passed within gaping hypospadiac meatus. C , Typical appearance of meatus following newborn circumcision in a patient with the MIP variant.
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14. Artificial erection and tunica albuginea plication. A , Assessment for curvature after degloving of shaft skin, urethral plate intact. B , Neurovascular bundles isolated and elevated. Proposed parallel lines of incision bilaterally are opposite point of maximal curvature. C , Outer edges of incisions have been approximated, and both the intervening strip of tunica albuginea and the knots are buried. (Modified from Baskin LS, Duckett JW: Dorsal tunica albuginea plication (TAP) for hypospadias curvature. J Urol 1994;151:1668, with permission.)
15. . Second layer coverage of neourethra with subcutaneous (dartos) tissue flap harvested from lateral or dorsal penile shaft and repositioned ventrally over the neourethra. (From Retik AB, Borer JG: Primary and reoperative hypospadias repair with the Snodgrass technique. World J Urol 1998;16:186, with permission.)
16. Tunica vaginalis neourethral coverage. (Performed over mesentery of onlay island flap repair in this case.) A , Lateral border of onlay or tube pedicle may be advanced as a second layer of neourethral coverage. B , Testis to be delivered for harvest of tunica vaginalis as supplemental or sole source for second layer coverage. C , Harvest of tunica vaginalis. D , Isolation of flap from testis and distal spermatic cord. E , Tunica vaginalis has been secured over the neourethra. (From Retik AB: Proximal hypospadias. In Marshall FF [ed]: Textbook of Operative Urology. Philadelphia, WB Saunders, 1996, with permission.)
18. Ventral skin proximal to the hypospadiac meatus is evaluated for thickness/integrity prior to deciding on reparative technique. Note urethral sound passed into meatus. A , Thick, healthy skin overlying urethra (arrowheads) proximal to hypospadiac meatus. B , Thin, near transparent skin and urethra (arrowheads) proximal to meatus prior to midline incision. C , Same patient as in B following midline incision proximally from site of the native meatus (arrow) to the point of encountering healthy tissue in preparation for urethroplasty. Note catheter within neomeatus. The urethral plate has been outlined with incisions and marked in the midline with a longitudinal dotted line
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20. Meatoplasty and glanuloplasty (MAGPI). A , Circumferential subcoronal incision is marked. B, Longitudinal incision, and C , transverse approximation (Heineke-Mikulicz procedure) of transverse glanular “bridge” in urethral plate. D , Ventral edge of meatus is pulled distally and medial glans “trimming” incisions are marked. E , Deep suture approximation of the glans. F , Superficial approximation of the glans and skin. (From Duckett JW: Hypospadias. In Walsh PC, Retik AB, Vaughan ED Jr, Wein AJ [eds]: Campbell's Urology, 7th ed, vol 2. Philadelphia, WB Saunders, 1998, pp 2093–2119, with permission.)