Hypospadias operations part 1 introd (step by step oper series) more resources of urology on: uronotes2012.blogspot.com

1. Hypospadias repair - Part 1
(introduction)
M.A.Wadood Aref

2. Hypospadias: Epidemiology
• 1 / 300
• Aetio.: failure of closure of urethral folds.
• Many purported associations:
– UDT
– inguinal hernia
– Maternal age
– Twin births
– Low birth weight
M.A.Wadood Aref

3. Urethral Groove (Plate)
• Urethral folds are parallel folds along the
undersurface of the genital tubercle between
which lies the urethral groove
• The urethral folds unite from proximal to
distal, forming the urethra.
M.A.Wadood Aref

4. Glanular Groove
• Glanular urethra (distal to the fossa navicularis) is
formed by ingrowth of tissue which cores through the
glans to the more proximal urethra
• Failed attempts to form the distal urethra are evident as
blind-ending pits
M.A.Wadood Aref

5. Rule of 10s
• 10% of fathers
• 10% of siblings
• 10x increased incidence in twins
• 10% have UDT
• 10% have inguinal hernias
• 10% incidence of utricle in those
with penoscrotal hypospadias (57%
with perineal hypospadias)
M.A.Wadood Aref

6. Spectrum of Hypospadias
50% of cases
30% of cases
20% of cases
M.A.Wadood Aref

7. Examples
M.A.Wadood Aref

8. Examples
M.A.Wadood Aref

9. Presentation
1. Ventral Opening
2. Ventral Chordee
3. Ventral defecient foreskin (hooded prepuce)
• Intersex evaluation: rule of 2/3
• If 2 of the 3 genital structures are abnormal then evaluate
for intersex
• ie. Hypospadias +
impalpable testis
M.A.Wadood Aref

10. Steps
• Orthoplasty
• Urethroplasty
1. Neourethroplasty
2. 2nd layer
• Glanuloplasty &
Meatoplasty
• Skin closure
M.A.Wadood Aref

11. Thank You
M.A.Wadood Aref