2. NORMAL PENILE ANATOMY
Normally the male urethra develops between the 8th
and 15th weeks of gestation under the influence of
testosterone.
From inside out there are:
2 Corpora Cavernosa, 1 Corpus Spongiosum
enclosed in a fascial sheath- Tunica Albuginea
Bucks Fascia, Thick Fibrous Envelope.
Connective Tissue, Dartos Fascia, and Skin.
3. HYPOSPADIAS
Hypo- below, Spadon- orifice
Congenital anomaly characterized an abnormal
Urethral meatus locate dabnormally proximal
and ventral on the penis, scrotum or perineum.
Incidence ……..1/100 to 1/300 live births.
5. CLINICAL FEATURES
Abnormal ventral meatus,
Hooded prepuce (98%)
Chordee (15% of anterior cases, >50% of posterior
cases)
Meatal dystopia
Para-urethral sinuses Flattened glans with a cleft
Scrotum may be bifid
Penile torsion
Associating with inguinal hernia and hydrocele
(~10%), undescended testes (~8%), Urethral valves/VUR
Very rarely can be part of the DSD spectrum.
6. Chordee is caused by:
1-Differential growth of the normal corpora cavernosa
and abnormal ventral structures.
2-Fibrous remnants/ dysgenetic remnants of
undifferentaited corpus spongiosum and fascial layers
of the penis which insert into the glans.
7. Etiology
Multifactorial involving endocrine, genetic,
and environmental factors.
There is failure of complete fusion of the
urethral folds which may be due to
reduced testosterone stimulation.
8. Endocrine Factors
1-Deficient androgenic stimulation. This may be
due to abnormalities of the 5-alpha reductase or
abnormal androgen receptors)
2-Increased maternal progesterone exposure.
The progesterone competitively inhibits the 5-
alpha reductase. Hypospadias is 5 times more
common among boys born from IVF as the
mother receives progesterone treatment during
IVF.
9. Environmental Factors
Increasing Incidence of hypospadias has
been attributed to the increased maternal
exposure to estrogenic substances
(contained in edibles, milk,
pharmaceuticals etc.).
10. Genetic Factors
Inheritance is unknown. The following facts:
Monozygotic twins: 8 fold increase in the
incidence of hypospadias compared to
singletons. May be due to in utero
competition for HCG.
family history of the affected boys: 8%
have affected fathers and 14% have
brothers
11. Classification
Anterior (glanular, coronal, and subcoronal)
(50% cases)
Middle (distal penile, midshaft, and
proximal penile) (20% cases)
Posterior (penoscrotal, scrotal, and
perineal) (30% cases)
12. Goals of Surgery
1-To allow normal standing voiding with a
forward/ straight stream
2-Normal sexual function.
3- To create a cosmetically acceptable organ
with natural appearance.
13. CLASSIFICATION
Smith ……..
Able …….. I , II, III degree
Browne …….. Coronal - distal penile,
penile, penoscrotal, scrotal
penile
Basrat …….. (post chordee release)
