Hypospadias

journey from squatter to a pointer

1. Journey from a squatter to a pointer Dr. Amit Kumar Choudhary HYPOSPADIAS

2. INTRODUCTION Definition:- Hypospadias is a congenital defect of the penis in which the urinary tract opening, or urethral meatus , is abnormally located on under surface of penis.

3.  Incidence- 1/300 male newborns . Associated with 3 anomalies - Abnormal ventral opening of urethral meatus . - Abnormal ventral curvature of the penis . - Abnormal distribution of foreskin with a dorsal hood .

4. Other abnormal findings include : Downward glans tilt Scrotal encroachment onto the penile shaft midline Deviation of the median penile raphe scrotal cleft Ventral curvature penoscrotal transposition

5. Diagnosis   Hypospadias is diagnosed by physical examination. First suspected by the ventrally deficient prepuce and confirmed by the proximal meatus . Ultrasound study for other anomalies 

6. Classification

7. Indication of operation Functional indications: Proximally located meatus Ventrally deflected urinary stream Meatal stenosis Curved penis.

8. Cosmetic indications : 1. Abnormally located meatus 2. Cleft glans 3. Rotated penis with abnormal cutaneous raphe 4. Preputial hood Penoscrotal transposition Split scrotum.

9.  Timing of surgery Recent studies showed that the ideal time for hypospadias correction is between 3 and 15 months as the penis grows less than 1 cm during the first 3 - 4 years. Healing seems to occur more quickly and with fewer scars. This age seems to insulate most children form the psychologic , physiologic, and anaesthetic trauma associated with hypospadias surgery.

10. Preoperative consideration HCG 250-500 U sc twice a week for 3 weeks. IM testosterone enanthate – 2mg/kg/dose given for a total of 2 or 3 doses before hypospadias repair. Testosterone propionate cream – 2% three times daily for 3 weeks.

11. General principle of hypospadias repair ORTHOPLASTY URETHROPLASTY MEATOPLASTY GLANULOPLASTY

12. Types of Surgery Single stage Tubularised incised plate urethroplasty (Snodgrass) Preputial flap techniques Onlay Tube Two stage Bracka 1: Full thickness skin graft 2: Creation of neo urethra by the graft

13. AIMS AND OBJECTIVE To analyze the Demographics Techniques Complication of hypospadias repair and its effect modifiers at our centre.

14. MATERIAL AND METHODS Study Design- Retrospective study. Set-up- Department of Plastic And Reconstructive Surgery. Study variables- The study was conducted under some variables such as patient’s age, type of hypospadias , type of surgery, and complication.

15. RESULTS

16. Age distribution: Total no.of case-30

17. Type of Hypospadias

18. Chordee

19. Type of procedure

20. Known Complications Urethrocutaneous fistulas Meatal stenosis Neourethra stricture Dehiscence Diverticulum BXO

21. Complication

22. Result Modifiers Take up surgery at a later date Use more robust flaps Compromise on cosmesis for result

23. The goal of hypospadias repair Improve function and appearance as near to normal as possible. Straightening curvature and extending the urethra to the glans . cosmetic results are as important as functional outcomes .

24. Take home message Chances of technical error during hypospadias repair are very high,and complication rate is also very high so, culture of casual hypospadias surgery should be abandoned, mandatory use of magnification during surgery and regular audit should be performed.

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