Hypospadias &

epispadias

PRESENTEDBY
MR.ROMAN BAJRANG
RELIANCE INSTITUTEOF NURSING
HYPOSPADIAS
 HYPOSPADIAS

 The term hypospadias refers to a urethral

opening that is on the ventral surface of the
penile shaft, proximal to the end of the glans.
The meatus may be located anywhere along
the shaft of the penis, from the glans to the
 scrotum,
Some boysor with
evenhypospadias,
in the perineum.
particularly
those with proximal hypospadias, have
chordee, in which there is ventral penile
curvature during erection.
 INCIDENCE

 Hypospadias occurs in up to 4 in 1,000 newborn

boys.
 The reason why the penis does not develop properly
is still not clear.
 The development of the penis whilst the baby is
growing in the womb is partly dependent on the
male sex hormones such as testosterone.
 The effects of testosterone on the growing penis
may be blocked in some way.
 Although it is not a genetic condition, hypospadias
can run in some families
 CAUSES

 present at birth (congenital). The exact

reason this defect occurs is unknown.
 A defect in the androgen stimulation of the
developing penis.
 the deficient androgen production by the
testes and placenta.
 RISK FACTORS

 Age and weight: Mothers who were age35 years or older

and who wereconsidered obese had a higher risk of having a
baby with hypospadias.
 Fertility treatments: Women who usedassisted
reproductive technology to help with pregnancy had a higher
risk of having a baby with hypospadias.
 Certain hormones: Women who took certainhormones just
before or during pregnancy wereshown to have a higher risk
of having baby with hypospadias.
 Exposure to smoking and chemicals: There is some
speculation about an association between a mother's
exposure to pesticides and hypospadias.
 Family history: This condition is more common in infants
 CLASSIFICATION

by Duckett in 1996.

 He divided them into anterior (50%), middle

 (30%) and posterior (20%) hypospadias.

- The anterior form: glandular, coronal and distal

penile.
- The middle form: "midshaft" and proximal
penile.
- The posterior form: penoscrotal, scrotal and
perineal
 Glanular hypospadias : the urethra is within the head of his
penis(glans).
 Coronal: The opening of the urethra is just below the head of
his penis.
 Distal penile: the opening of theurethra is in the distal portion
of the shaft of the penis .
 Midshaft: The opening of the urethra is located along the shaft
of the penis.
 Proximal penile: the opening of the urethra is in the proximal
portion of the shaft of the penis .
 Penoscrotal: The opening of the urethra is located where the
penis and scrotum meet.
 Scrotal hypospadias: hypospadias with the urethral opening
on the scrotal surface.
 perineal hypospadias: the urethral meatus opens in the
perineum near the anus; the scrotum is usually cleft.
 CLINICAL MANIFESTATIONS

Mild hypospadias usually does not cause

symptoms, especially in newborns and young
children.

This condition may cause a downward curve of

the penis during an erection.

Erections are common in infant boys.

 OTHER SYMPTOMS
INCLUDE

Abnormal spraying of urine

. Having to sit down to urinate
. Foreskin that makes the penis
looks like it has a "hood"
The farther the opening is from
the tip of the glans, the more
likely curvature in the penis
(chordee) is present.
 DIAGNOSTIC MEASURES

. prenatal ultrasound

. Physical exam of a newborn: upon examination,

the foreskin is usually incomplete and the
misplaced urethral opening is located.

. Excretory urogram: This test uses X-rays to

provide pictures of the urinary tract, and other
congenital anomalies
 TREATMENT

1. Medical management
Minor cases of hypospadias, in which the meatus
is located up toward the tip of the glans, may not
require surgical repair and may simply be
managed with observation.

2. Adjuvant hormonal therapy

Presurgical treatment with testosterone injections
or creams, as well as HCG injections, to promote
penile growth, and for the improvement in
chordee with lessening in the severity of the
 SURGICAL MANAGEMENT

Management begins in the newborn period.

Circumcision should be avoided, because the
foreskin often is used in the repair.
The ideal age for repair in a healthy infant is 6-
12 months

-There is no greater risk of general anesthesia

at this age compared to 2-3 yr
-Penile growth over the next several years is
slow
- The child does not remember the surgical
procedure
 DIFFERENT SURGERIES

1.Glandular hypospadias requires a

glandular meatotomy .
2.Coronal hypospadias requires a
meatal advancement and
glanduloplasty (MAGPI operation) .
3.Proximal hypospadias without a
chordee can be treated by a skin flap
advancement .
4.If chordee present it should be
EPISPADIAS
Epispadias is a congenital
malformation in which the opening of
the urethra is on the dorsum of the
penis.
. In boys with epispadias, the urethra
generally opens on the top or side of
the penis rather than the tip.
However, it is possible for the urethra
to be open along the entire length of
the penis.
. In girls, the opening is usually
 CAUSES

•Unknown .
• Related to improper development of the
pubic bone .
•Failures of abdominal and pelvic fusion
in the first months of embryogenesis .
• Epispadias can be associated with
bladder exstrophy, an uncommon birth
defect in which the bladder is inside out,
and sticks through the abdominal wall .
•Also occur with other defects .
 CLASSIFICATION

Classification of epispadias is based on

the location of the meatus the penis. It
can be positioned: On the glans (glanular)
. Along the shaft of the penis (penile)
. Near the pubic bone (penopubic)
The position of the meatus is important
because it predicts the degree to which
the bladder can store urine (continence).
The closer the meatus is to the base of
the penis, the more likely the bladder will
 SYMPTOMS
IN MALES :
1.Abnormal opening from the joint
between the
pubic bones to the area above the tip of
the
Penis .
2. Backward flow of urine into the kidney
(reflux nephropathy)
3.Short, widened penis with an abnormal
curvature
4.Urinary tract infections
In females:

Abnormal clitoris and labia

•Abnormal opening where the from

the bladder neck to the area above
the normal urethral
opening
•Backward flow of urine into the
kidney (reflux nephropathy) Widened
pubic bone
•Urinary incontinence
 DIAGNOSTIC MEASURES

Prenatal diagnosis - rare

. Blood test to check electrolyte
levels
. Intravenous pyelogram (IVP), a
special x-ray of the kidneys,
bladder, and ureters
. MRI and CT scans, depending on
the condition
 SURGICAL TECHNIQUE IN MALES

•The modified Cantwell technique

It involves partial disassembly of the penis
and placement of the urethra in a more
normal position.
 TREATMENT

The primary goals of treatment of

epispadias are to:
•maximize penile length and function by
correcting dorsal bend and chordee; and
•create functionality and cosmetically
acceptable external genitalia with as few
surgical
procedures as possible.

•If the bladder and bladder neck are also

The second technique is the Mitchell
technique.
> It involves complete disassembly of the
penis into its three separate components.

> Following disassembly, the three

components are reassembled such that
the urethra is in the most
functional and normal position and dorsal
chordee is corrected.
Surgical technique in females :

•The urethra and vagina may be short and

near
the front of the body and the clitoris is in
two
parts.

•If diagnosed at birth, the two parts of the

clitoris can be brought together and the
urethra can be placed into the normal
position.
•If the diagnosis is missed or if early repair
is not performed, then incontinence can be
surgically corrected at the time of
diagnosis.

•If the vaginal opening is narrow in older

girls or younger women, reconstruction
can be performed after puberty.