Christopher P. Coppola, Alfred P. Kennedy, Jr. and Ronald J. Scorpio (eds.)Pediatric Surgery2014Diagnosis and Treatment10.1007/978-3-319-04340-1_32
© Springer International Publishing Switzerland 2014
Hypospadias
(1)
Department of Pediatric Urology, Janet Weis Children’s Hospital, 100 N. Academy Av. MC 13-16, Danville, PA 17822, USA
Abstract
Results from arrested penile development causing a proximal urethral meatus and varying degrees of other issues of the penis.
1.
Pathophysiology:
(a)
Results from arrested penile development causing a proximal urethral meatus and varying degrees of other issues of the penis.
(b)
Underlying cause for most cases of non-syndromic hypospadias is unknown.
(c)
Estimated to have incidence of 1 in 300 live male births.
(i)
Has been increasing past 30 years.
(ii)
Thought to be possibly related to environmental toxins.
(d)
Familial predominance with an index case resulting in an incidence of one in 20 newborns.
(e)
Associated Anomalies:
(i)
Cryptorchidism.
(ii)
Prostatic utricle.
(iii)
Disorders of sexual development (DSD):
1.
Any child with hypospadias and undescended testes, especially if dysmorphic or nonpalpable, should raise concern.
2.
Most common is mixed gonadal dysgenesis, followed by varying degrees of androgen insensitivity.
2.
Diagnosis:
(a)
Abnormal appearing penis with proximal meatus and ventrally deficient prepuce.
(i)
Can have penile torsion, bifid or engulfing scrotum, glanular tilt, chordee, or complete ambiguity.
(b)
There is a subset where foreskin is normal and abnormally large meatus is only discovered when foreskin is retracted
(i)
Megameatus intact prepuce (MIP).
(c)
Can also have a normally positioned meatus and ventral chordee.
(i)
Chordee without hypospadias.
(d)
Meatus can be located along pathway of normal urethra from glans down to perineum.
(e)
If there are many associated issues may be role for karyotyping, but it is not recommended in routine cases.
3.
Treatment:
(a)
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General principles:
(i)
Over 200 repairs have been described.
(ii)
Suture material is usually per surgeon preference, as is choice of post-op dressings and urinary diversion.
(iii)
Each individual surgeon must monitor his or her outcomes in a prospective fashion and adjust if complications reach predetermined levels.
(iv)
Should be approached only by a surgeon who has undergone fellowship mentoring.
(v)
Use of optical magnification required.
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