Hypospadias

Hypospadias is a congenital abnormal urethral opening on the under surface of penis. It is commonest malformation of male children.

In male

Urethral opening is situated on the ventral side of shaft of penis.

Undescended testis or inguinal hernia or upper urinary track abnormalities associated with hypospadias.

In female

Urethral opening in vegina with dribbling of urine.

Classification of hypospadias

1. Anterior hypospadias

a. glanular hypospadias

b. Coronal hypospadias

c. Penile hypospadias 

2. Middle hypospadias

a. Penoscrotal hypospadias

b. Perineal hypospadias

3. Posterior hypospadias 

Pathophysiology

Hypospadias result from incomplete fusion of urethral folds along the midline.

Urethra may open either near to where normal meatus located or ventral surface of penile shaft or position just behind glans or on perineum.

Associated congenital chordae caused by fibrous band of tissues that extends from scrotum up the penis and pulls it ventrally. 

Where ventral foreskin is usually absent.

Meatal stenosis, undescended testes and inguinal hernia may be present.

Problem related to hypospadias

1. Abnormal spraying of urine

2. Malformed foreskin that make hood of penis

3. Painful bending of penile/ tenderness

4. Inability to void urine while standing

5. Defected stream of urine

Management

Surgical Management

1. Chordae correction; to straighten penis

2. Urethroplasty; repair urthra

3. Circumcision; Surgical removal of skin that covering tip of penis.

4. Meatotomy; surgical opening of hole (urethral meatus) with no stitching.

Complication

1. Meatal stenosis

2. Fistula

3. Urethral diverticulum

4. Urethral stricture of stenosis