Hypospadias Complications | Glandular Hypospadias Surgery Treatment

Hypospadias Complications | Glandular Hypospadias Surgery Treatment .

What is Hypospadias:

Hypospadias is a condition in which the external meatus or opening of the urethra is situated at some point on the undersurface of the penis or perineum. This is the commonest congenital malformation of the urethra.

Incidence- it occurs once in every 350 males.

Types- according to the position of the abnormal external meatus, hypospadias has been classified into 5 varieties-

• Glandular variety- In this case the ectopic external meatus is situated on the undersurface of the glans. There is often a blind depression at the normal site of external meatus.
  
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  Occasionally a channel may exist between the normal site and ectopic opening. The part of the urethra which is not formed is ectodermal and developed by the in-growth of the surface epithelium to join the tip of the urethral plate. In this congenital variety the in-growth does not occur or it fails to canalize. This is commonest variety of hypospadias.
• Coronal variety- Here the external meatus is situated at the corona glandis i.e. at the junction of the corona glandis with the body of the penis.
• Penile variety- Here the external meatus is situated at any part of the undersurface of the body of the penis.
  
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• Peno-scrotal- The ectopic urethral opening is situated at the junction of the penis and the scrotum.
• Perineal variety- In this case the scrotum is split and the urethra opens between its two halves. This variety is often associated with bilateral un-descended testis. In this case the sex determination of the child becomes difficult.

Except the glandular variety the other varieties are due to failure of fusion of the genital folds in varying degrees.

Complications of hypospadias-

• There may be some obstruction to urine outflow.
• The stream of urine may be deflected downwards thus spoiling the under-wears.
• Due to presence of chordee, in the penile variety, erection is difficult and painful.
• Due to chordee, intercourse may be difficult or impossible.
• Infertility is usually associated with peno-scrotal and perineal variety.
• Sex determination may be difficult in case of perineal variety.

Treatment for Hypospadias -

• In glandular hypospadias, no treatment is required, except meatotomy and dilatation of external urethral meatus, when it is too small.
• In case of other varieties, a plastic surgery is performed to bring the external urethral meatus to its normal position as far as practicable. There are many operations advocated by various surgeons all over the world. This indicates that no operation has been very satisfactory.
• Denis-Browne’s operation is still the simple and most accepted operation.

Operation of hypospadias is performed in 2 stages-

• Stage I- It consists of straightening of the penis, which is performed preferably between 11/2-2yrs.
• Stage II – It consists of reconstruction of the urethra which is preferably done between 5-7yrs of age.