A PRESENTATION ON HYPOSPADIAS IN CHILDREN

2. OBJECTIVES
 OVERVIEW
 DEFINITION
 INCEDENCE
 TYPES
 CAUSES
 RISK FACTORS
 SIGNS AND SYMPTOMS
 PATHOPHYSIOLOGY
 TREATMENT
 NURSING MANAGEMENT

3. OVERVIEW
 Hypospadiasis a birth defect (congenital
condition) in which the opening of the urethra is
on the underside of the penis instead of at the tip.
 The urethra is the tube through which urine
drains from your bladder and exits your body.
 Hypospadias is common and doesn't cause
difficulty in caring for an infant.
 Surgery usually restores the normal appearance of
your child's penis.
 With successful treatment of hypospadias, most
males can have normal urination and
reproduction.

4. THE PENIS
The penis is the
male sex organ,
reaching its full
size during
puberty. In
addition to its
sexual function,
the penis acts as a
conduit for urine
to leave the body.

5. The penis is made of several parts:
 Glans (head) of the penis: In uncircumcised men, the glans
is covered with pink, moist tissue called mucosa. Covering the
glans is the foreskin (prepuce). In circumcised men, the
foreskin is surgically removed and the mucosa on the glans
transforms into dry skin.
 Corpus cavernosum: Two columns of tissue running along
the sides of the penis. Blood fills this tissue to cause an
erection.
 Corpus spongiosum: A column of sponge-like tissue running
along the front of the penis and ending at the glans penis; it
fills with blood during an erection, keeping the urethra --
which runs through it -- open.
 The urethra runs through the corpus spongiosum,
conducting urine out of the body.

6. TYPES OF HYPOSPADIAS
There are three kinds,
depending on where the
urethra opening is
located:
 Subcoronal:-this is near
the head of the penis.
 Midshaft: - this is along
the shaft of the penis.
 Penoscrotal:-this occurs
where the penis and
scrotum meet, or on the
scrotum (Renee. A.
2020)
SUBCORONAL MIDSHAFT PENOSCROTAL

7. CAUSES
Hypospadias is present at birth (congenital).
As the penis develops in a male fetus, certain
hormones stimulate the formation of the
urethra and foreskin.
Hypospadias results when a malfunction
occurs in the action of these hormones,
causing the urethra to develop abnormally.
In most cases, the exact cause of hypospadias
is unknown. Sometimes, hypospadias is
genetic, but environment also may play a
role.

8. RISK FACTORS
Although the cause of
hypospadias is usually
unknown, these factors
may be associated with the
condition:
 Family history. This
condition is more
common in infants with a
family history of
hypospadias.
 Genetics. Certain gene
variations may play a role
in disruption of the
hormones that stimulate
formation of the male
genitals.

9.  Maternal age over 35. Some
research suggests that there
may be an increased risk of
hypospadias in infant males
born to women older than 35
years.
 Exposure to certain
substances during
pregnancy. There is some
speculation about an
association between
hypospadias and a mother's
exposure to certain
hormones or certain
compounds such as
pesticides or industrial
chemicals, but further
studies are needed to
confirm this. ( MayoClinic.
2020)

10. SIGNS AND SYMPTOMS
Some boys with mild forms of hypospadias can have
no symptoms from their hypospadias.
 If the hypospadias and/or chordee is not repaired,
the child may have these issues as he grows:
 His urine stream may be hard to direct and
control.
 The penis may curve as he grows, causing sexual
dysfunction later in life.
 If the urethral opening is near or behind the
scrotum, he may have fertility problems later in
life.

11. PATHOPHYSIOLOGY
Due to incomplete fusion of
urethral folds along the middle
Severity of condition depends on
the location of opening
The presence of opening near glans is
known as Glandular Hypospadias
The presence of opening near glans is
known as Glandular Hypospadias

12. Presence of opening at corona is known
as Coronal Hypospadias
Presence of opening at shaft is
known as Perineal Hypospadias

13. DIAGNOSTIC INVESTIGATION
A pediatrician can diagnose hypospadias based
on physical examination. The assessment
includes;
 Abnormal pattern of voiding
 Stream of urine may be deflected downward
 Child voids in sitting position in penoscrotal
perineal hypospadias
 In glandular or coronal hypospadias child able
to voids in standing position, by tilting the
penis slightly upward.

14. MANAGEMENT
 There is no medical management for this defect.
 Surgery may be recommended for its correction and the
goals of surgery are:
 To bring the urethral opening to the tip of the penis via a
procedure known as urethroplasty.
 To straighten the penis.
 Circumcision of the foreskin should be avoided as this
foreskin should be used for surgical repair.
 Surgery should be done preferably at the age of 6-24 months
of age.

16. PREOPERATIVE CARE
Preparing patient’s for child surgery
Psychological support should be given to
the parent
Consent form should be filled by the
parents
Vital signs should be checked
Anemia should be corrected
Any underlining medical condition
should be treated before the procedure

17. POSTOPERATIVE CARE
Monitor vital signs
Catheter care should be given
Put restraints so that child should
not take out catheter or other tubing
Urine examination should be done to
rule out any infection
Support and guidance of parents is
very important (Sheena.B. 2019).

18. COMPLICATIONS
If hypospadias is not treated, it can
result in:
Abnormal appearance of the penis
Problems learning to use a toilet
Abnormal curvature of the penis
with erection
Problems with impaired ejaculation

19. REFERENCES
 https://emedicine.medscape.com/article/1015227-
overview
 https://www.ncbi.nlm.nih.gov/books/NBK482122/
 https://www.slideshare.net/Unit6lnh/hypospadias