Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Pediatric Surgery 13 Hypospadias PPT-Powerpoint Presentations and lecture notes
HYPOSPADIAS
INTRODUCTION
Definition:
- Any condition in which the meatus occurs on the undersurface of the
penis.
Usual y 3 features
ventral meatus
ventral curvature (chordee)
Dorsal "hood"; deficient foreskin ventral y
TYPES/ CLASSIFICATION
EMBRYOLOGY:
Genital tubercle fuses in midline
Mesodermal folds create the
urethral and genital folds
coalesce in midline as phal us
elongates
Distal glans channel tunnels to
proximal urethra as solid core then
undergoes canalization.
EMBRYOLOGY:
Prepuce forms as ridge of skin from
corona.
Hypospadias
Failure of ventral aspect to form
Dorsal hood.
Chordee
Differential growth between normal y
developed dorsal tissue and
underdeveloped ventral corporal tissue
Fibrous tissue distal to hypospadiac meatus.
INCIDENCE:
1:300 live male births
Some genetic component
8% of patients have father with hypospadias
14% of patients have male siblings with hypospadias
If child with hypospadias, risk to next child
12% risk with negative family history
19% if cousin or uncle with hypospadias
26% if father or sibling
More common in Caucasians (Jews and Italians)
Higher incidence in monozygotic twins (8.5x)
ASSOCIATED ANOMALIES:
Undescended testes 9%
Inguinal hernia 9%
Upper tract anomalies rare (1-3%)
Utriculus masculinus
10 to 15% in perineal or penoscrotal hypospadias
Incomplete mul erian duct regression
hypospadias and cryptorchidism
high index of suspicion for an intersex state
Walsh reported the incidence of intersexuality in children with cryptorchidism,
hypospadias, and otherwise nonambiguous genitalia to be 27%.
Only with severe hypospadias and sexual ambiguity
Includes testicular abnormalities
Up to 25% of these patients have enlarged utricles or other female structures
Intersex, especial y with cryptorchidism
Adrenogenital syndrome
Mixed gonadal dysgenesis
Incomplete pseudohermaphroditism
True hermaphrotidism
TREATMENT TECHNIQUES:
Meatoplasty and glanuloplasty
Multiple techniques
Orthoplasty
Utilize artificial erection-Gitte's test
Release urethra from fibrous tissue
Plicate dorsal tunica albuguinea
Ventral graft if needed
Urethroplasty
Onlay vascularized flap
Tubularized flap
Free graft
Skin cover/Rearrangement
Mobilized dorsal prepuce and penile skin
Double faced island flap
Scrotoplasty
FACTORS FOR TECHNICAL SUCCESS
Use of vascularized tissues
Careful tissue handling
Tension-free anastomosis
Non-overlapping suture lines
Meticulous hemostasis
Fine suture material
Adequate urinary diversion
HYPOSPADIAS SURGERIES
Distal hypospadias
Tubulization of the incised urethral plate (Snodgrass)
Meatal advancement (MAGPI)
Meatal-based flaps (Mathieu)
Proximal hypospadias
Onlay grafts
Vascularized inner preputial transfer flaps (Duckett)
Free grafts (skin, buccal mucosa)
MAGPI
MATHIEU PROCEDURE
REDMAN and
BARCAT
PROCEDURE
ISLAND ONLAY
BUCCAL MUCOSAL
GRAFT
ACUTE COMPLICATIONS:
Wound infection
Poor wound healing 2 to ischemia of flaps
Edema
CHRONIC COMPLICATIONS:
Urethrocutaneous fistula
Urethral diverticulum
Residual chordee
Persistent hypospadias
Urethral stricture
Hair bearing skin
Meatal stenosis
Excess skin
Balanitis xerotica obliterans
HYPOSPDIAS- CONCLUSIONS
Common
Genetic component exists
Evaluation for associated anomalies with severe proximal hypospadias
Rule out intersex, especial y with cryptorchidism
Multiple repairs exist, tailor to the patient, anatomy, and previous repairs
THANK YOU
This post was last modified on 08 April 2022