Hypospadias Flashcards Preview

Y3M - Urology > Hypospadias > Flashcards

Flashcards in Hypospadias Deck (12)
Loading flashcards...
1

What is hypospadias?

A congenital defect causing the urethral meatus to be located at an abnormal site

This is usually on the under side of the penis rather than tipe

2

Epidemiology

1 in 300 males

Incidence is thought to be increasing

3

Pathophysiology

Occurs due to arrest of penile development

This leads to hypoplasia of the ventral tissue of the penis

4

Clinical features

Abnormal urinary flow i.e. not from the tip

Abnormal penile curvature during erections

5

3 key features

Ventral opening of the urethral meatus

Ventral curvature of the penis or Chordee

Dorsal hooded foreskin

6

Classifications

Glandular

Coronal

Shaft - distal, mid, proximal

Scrotal

Perineal

7

Dx

If associated with unilateral or bilateral undescended testis CAH might be diagnosis that must not be missed

If not detected early it can lead to salt wasting crisis due to cortisol and aldosterone deficiency with androgen excess

8

Ix

Make sure it is not a  disorder of sex development

If there are concerns about DSD...

Detailed history and examination

Karyotyping

Pelvic USS

U&Es

Endocrine hormones like testosterone, 17 alpha-hydroxyprogesterone, LH FSH, ACTH, Renin Aldosterone

9

Mainstay treatment

Urethroplasty either as single stage or 2-stage repair using a graft.

This is preferentially by preputial graft harvested from the foreskin.

This means they need advise against circumcision

10

Aims of urethroplasty

Bring the meatus to the glans of the penis

Chordee is corrected to straighten the penis

Dorsal foreskin is managed with either circumcision or reconstruction.

 

Note it is important to make sure family understand that circumcision should not be performed until after discussion about reconstruction with a specialist has occured. Since it can form a vital part of reconstruction.

11

Short term complications

Urethral cathether is usually needed to protect surgical reconstruction, and this can block.

The cath can also cause pain and bladder spasms, however urine must be freely draining before assigning symptoms to bladder spasms.

Bleeding and infection can also occur

12

Long term complications

Urethral fistula in 5-10% of distal repair and 30% of proximal

Risks of meatal or urethral stenosis which can require further intervention.