Definition, causes, signs and symptoms, diagnosis, and treatment

1. Hypospadias/Undescended Testis
Mr. Mahesh Chand
Nursing Tutor

2. Hypospadias / Chordee
Hypospadias is a common birth defect of the
penis where the urethra (the tube that carries
urine from the bladder to outside of the body) is
not at the tip of the penis. It can be located
anywhere on the undersurface of the penis to the
scrotum.
A condition called chordee is often seen with
hypospadias. Chordee is an abnormal downward
curve of the penis. This can occur with or
without a hypospadias.

3. Classification of hypospadias is done by the
position of the urethral opening. The types of
hypospadias include:
Distal or glanular: most common form when
opening is found near the head of the penis
Midshaft: when opening is found in the middle
to the lower shaft of the penis
Penoscrotal: when opening is on the scrotum
Perineal: when opening is behind the scrotal sac.
These are the most severe forms of hypospadias

7. Hypospadias-
Hypospadias is a birth (congenital) defect in
which the opening of the urethra is on the
underside of the penis. The urethra is the tube
that drains urine from the bladder. In males, the
opening of the urethra is normally at the end of
the penis.

8. Causes
Hypospadias occurs in up to 4 in 1,000 newborn
boys. The cause is often unknown.
Sometimes, the condition is passed down through
families.

9. Symptoms
Symptoms depend on how severe the problem is.
Usually, boys with this condition have the opening of the
urethra near the tip of the penis on the underside.
More severe forms of hypospadias occur when the
opening is in the middle or base of the penis. Rarely, the
opening is located in or behind the scrotum.
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"

10. Exams and Tests
This problem is almost always diagnosed soon after
birth during a physical exam. Imaging tests may be
done to look for other congenital defects.
Treatments
Infants with hypospadias should not be circumcised.
The foreskin should be kept for use in later surgical
repair.
Surgery is usually done before the child starts
school. Today, most urologists recommend repair
before the child is 18 months old. Surgery can be
done as young as 4 months old. During the surgery,
the penis is straightened and the opening is corrected
using tissue grafts from the foreskin. The repair may
require multiple surgeries.

11. exstrophy of bladder-
Bladder exstrophy is a congenital abnormality
that occurs when the skin over the lower
abdominal wall (bottom part of the tummy)
does not form properly. The bladder is open
and exposed on the outside of the abdomen.
Causes-It affects the developing baby during
very early stages of development, at about four
to six weeks into the pregnancy. This is when
organs, muscles and other tissues start to form.

12. Sign and symptoms-
1.Problems with the neck of the bladder and
sphincter (ring of muscle that squeezes and
relaxes to let urine flow from the bladder).
2.The bladder has a smaller capacity than usual,
so cannot hold much urine.
3.The Ureter join the bladder in a different place
to normal.
4.The middle part of the pelvic bones are
separated.

13. The more common problems include:
The anus is further forward than usual.
The belly button is lower down than usual.
Umbilical and inguinal hernia,
Undescended testes

14. Unique approach to treatment
Some hospitals treat bladder exstrophy using a
planned three-stage surgical approach called the
Modern Staged Repair of Exstrophy (MSRE). The
MSRE approach includes separate stages of
initial bladder closure (first stage), epispadias
repair (second stage) and a third stage surgical
procedure when a child is about 5 years old
called Bladder Neck Reconstruction (BNR). This
last surgery is a standard operation performed in
order to help your child become continent of
urine

15. Management -Psychological support
Give instruction for care of bladder
An ointment apply for bladder dressing
Diaper should change frequently
Stool should remove quickly to prevent infection
of bladder
Don’t straining at stool passing time
Avoid pressure on bladder

16. Undescended testicle (cryptochidism)
is a testicle that hasn't moved into its proper
position in the bag of skin hanging below the
penis (scrotum) before birth. Usually just one
testicle is affected, but about 10 percent of the
time, both testicles are undescended.
An undescended testicle is uncommon in
general, but quite common among baby boys
born prematurely.
The vast majority of the time, the undescended
testicle moves into its proper position on its
own, within the first few months of life.

17. Causes
The exact cause of an undescended testicle isn't
known. A combination of genetics, maternal
health and other environmental factors might
disrupt the hormones, physical changes and
nerve activity that influence the development of
the testicles.
Mechanical obstruction
Short spermatic cord

18. Complications
Testicular cancer
Fertility problems
Testicular torsion
Trauma
Inguinal hernia

19. Treatments and drugs
The goal of treatment is to move the
undescended testicle to its proper location in the
scrotum. Early treatment (before 1 year of age)
might lower the risk of complications of an
undescended testicle, such as infertility and
testicular cancer.

20. Surgery
An undescended testicle is usually corrected
with surgery. The surgeon carefully manipulates
the testicle into the scrotum and stitches it into
place (orchidopexy). This procedure can be done
either with a laparoscope or with open surgery.

21. After surgery, the surgeon will monitor the
testicle to see that it continues to develop,
function properly and stay in place. Monitoring
might include:
Physical exam
Ultrasound exam of the scrotum
Tests of hormone levels