Introduction to hypospadias for undergraduates

2. Hypospadias
Presented by : Dr. Mahmoud Motawea

3. Definition
A congenital anomaly of the male
urethra where the urethral opening is
abnormally located on the undersurface
of the penis orperineum and the ventral
surface of the prepuce is poorly
developed

4. Types
Glanulartype
Coronal meatus
Penile type
Penoscrotal
Perineal

5. Etiology
Glanulartvpe: occurs due to failure of re-
canalization at the glans of penis.
Penile tvpe: occurs due to failure of fusion of inner
urethral folds.
Perineal tvpe: occurs due to failure of development
of whole penile urethra"

6. Moredetails
• Occur embryologically, between 8 and 20 weeks' gestation.
• As the phallus grows, the open urethral groove extends from
its base to the level of the corona.
• The classic theory is that the urethral folds coalesce in the
midline from base to tip, forming a tubularized penile urethra
and median scrotal raphe. This accounts for the posterior and
middle urethra. The anterior or glanular urethra is thought to
develop in a proximal direction, with an ectodermal core
forming at the tip of the glans penis, which canalizes to join with
the more proximal urethra at the level of the corona.

7. Clinical picture
What to focus on in history taking :
• any history of a familial pattern of
hypospadias, any past medical history or
comorbidity
• Infertility of IVF.

8. Clinical picture
Abnormal site of urethra
Difficulty directing urine streamand stream
spraying
Hooded prepuce (Except Megameatus intact
prepuce (MIP) variant.)
Penoscrotal transposition, Bifid scrotum.
Chordae …

9. Treatment
Avoid circumcision !
Surgical correction principles :
1- Removai of the chordee to coi'rect the ventral
curvature.
2- Urethral reconstruction using skin from the
prepuce or penile skin.
3- Circumcision after that.