Hypospadiasis

Hypospadiasis

1. Hypospadiasis Ratheesh.R SLMGNC

2. Introduction: Hypospadiasis is a congenital anomaly of the male urethra that results in abnormal ventral placement of the urethral opening. The location of the displaced urethral meatus may range anywhere within the glans , the shaft of penis, the scrotum, or perineum

3. Definition: It is a congenital condition in which the Urethral Meatus opens on the ventral side of the Penis. Incidence – 2-8/1000 Occurance – More common in male than in girls.

4. Etiology: Down ward penis ( Chordee ) Undescended testicle Inguinal hernia Male siblings

5. Pathophysiology : Due to any factor Decreased testosterone production in early gestation (Male) (Female) Urethra opens on the ventral Urethra opens into aspects of the penis the vagina (rare). Deflect the penis downward.

6. Clinical Manifestation: A downward urinary spray (in this may mean he has to sit down to urinate) A downward curve of the penis, called “ chordee ” A “hooded” appearance to the penis, caused by extra foreskin along the top side An abnormal appearance of the tip of the penis (the glans ) Inability to void urine with the penis in the elevated position. In female, Urine dribbling from vagina.

7. Diagnostic Findings: History Collection Physical Examination Renal Ultrasound/ Cystourethrography -It is done to determine associated defects with Hypospadiasis . Chromosomal and Hormonal Studies.

8. Treatment: Surgery: To reposition the opening of urethra at the tip of the penis ( urethroplasty ) To straighten the penis, if chordee is present ( orthoplasty ) To improve the outward appearance of the penis (removing the hooded foreskin)

9. Cont…. After surgery: Depending on the extent of surgery, the child may either go home the same day or stay in the hospital overnight. The Children's nurses will talk with, how to care for him at home and will provide detailed instruction sheets (how to manage his dressing, what activities should be avoided, etc.)

10. Cont…. For the child's recovery period, the doctor may prescribe any or all of the following: Acetaminophen (Tylenol), to help ward off soreness in the first few days after surgery Antibiotic ointment, to be applied to the penis several times a day Oral antibiotics Antispasmodic medication, to alleviate bladder spasms

11. Nursing Diagnosis: Pain r/t surgical incision and drainage tube. Risk for infection r/t surgical incision and drainage tube. Body image disturbance r/t Appearance of genitalia. Impaired urinary elimination r/t the condition and surgical intervention. Risk for fluid volume deficit r/t surgical losses.

12. Complication: Urethral fistula (5-15%) Scar narrowing of the urethra (stricture) Recurrence of penile curvature by growth in size of the penis with incomplete chordeectomy . Urethral stenosis . Urethral diverticula . Scar deformation. Reproductive inability.