Hypospadias

Urogenital Surgery

MTF Surgery

FTM Surgery

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Hypospadias is an abnormality of anterior urethral development in which the urethral opening is ectopically located on the ventral side of the penis proximal to the tip of the glans penis. The opening may be as proximal as the scrotum or perineum. The hypospadiac meatus may be either normal in diameter, wide, very wide or stenotic (usually in distal forms of hypospadias). The preputial skin is developed on the lateral and dorsal sides with a ventral deficiency-hooded prepuce. This prepuce can be with or without deformities such as: dog ears, dorsal hump, preputial horns etc. The skin proximally to the urethral meatus is usually thin. Rarely a normal, intact prepuce exists. The frenulim is always absent. The penis is more likely to have associated ventral shortening and curvature, called chordee, with more proximal urethral defects.According to the meatal location, hypospadias is classified as follows: glanular, coronal, distal shaft (subcoronal), mid shaft, proximal shaft, penoscrotal, scrotal or perineal. The goals of treating hypospadias are to create a straight penis by repairing any chordee (orthoplasty), to create a urethra with its meatus at the tip of the penis (urethroplasty), to re-form the glans into a more natural conical configuration (glanuloplasty), to achieve cosmetically acceptable penile skin coverage, and to create a normal-appearing scrotum. The resulting penis should be suitable for future sexual intercourse, should enable the patient to void while standing, and should present an acceptable cosmetic appearance. There are many different surgical techniques to fix hypospadias. Surgery should be performed between 6 and 18 months of child’s age. Circumcisison is contraindicated in hypospadias. Severe hypospadias or any hypospadias associated with cryptorchidism suggest intersex investigation.

Case 1 Scrotal Hypospadias (click image for larger view)