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:
1. Proximally located meatus
2. Ventrally deflected urinary
stream
3. Meatal stenosis
4. Curved penis.

8. Cosmetic indications :
1. Abnormally located meatus
2. Cleft glans
3. Rotated penis with abnormal
cutaneous raphe
4. Preputial hood
5. Penoscrotal transposition
6. 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.

12. General principle of hypospadias
repair
• ORTHOPLASTY
• URETHROPLASTY
• MEATOPLASTY
• GLANULOPLASTY

13. 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

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

15. 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.

16. RESULTS

17. Age distribution:
• Total no.of case-30
0
2
4
6
8
10
12
0-5yrs 6-10yrs 11-15yrs >15yrs
11 11
7
1
Series 1

18. Type of Hypospadias
1
5
9
3
8
0
1
2
3
4
5
6
7
8
9
10
Glanular Coronal Distal
penile
Mid shaft proximal
penile
PS Scrotal Perineal
Series 1
Series 1

19. Chordee
71.42
21.42
7.14
Chordae
with chordee
without chordee
chordae without hypospadias

20. Type of procedure
11
6
9
2 2
0
2
4
6
8
10
12
Bracka Snodgrass ASOPA chordae
correction
Fistula repair
Series 1
Series 1

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

22. Complication
0
0.5
1
1.5
2
2.5
Series 1
Series 1

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

24. 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.

25. 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.

27. THANK YOU