Abstract
Hypospadias is considered the result of arrested development, leaving incomplete urethral formation sometimes associated with ventral penile curvature. The minority of cases occurring with other syndromes, or when there is also undescended testis, warrant a preoperative karyotype to detect intersex disorders. Otherwise the only preoperative evaluation needed is assessment of glans size, as there may be benefit from preoperative testosterone therapy to increase glans diameter, usually in proximal hypospadias. Today most primary cases are corrected by tubularizing the urethral plate – tissue that should have originally created the urethra when development stopped. Prepucial flaps remain an option for repair, as do planned 2-stage flap or graft procedures. The majority of hypospadias complications relate to urethroplasty, most commonly including fistulas, obstruction to the neourethra (by meatal stenosis or urethral stricture), or wound dehiscence. Incidence varies by technique used and extent of the hypospadias defect (distal versus proximal). Reoperative urethroplasty can be accomplished using similar methods as for primary surgery, but complication rates are greater. At times excision of scarred tissues with planned 2-stage graft repairs is required to re-create a neourethral plate to subsequently tubularize.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Kaefer, M., Diamond, D., Hendren, W. H. et al.: The incidence of intersexuality in children with cryptorchidism and hypospadias: stratification based on gonadal palpability and meatal position. J Urol, 162: 1003, 1999
Snodgrass, W. T., Khavari, R.: Prior circumcision does not complicate repair of hypospadias with an intact prepuce. J Urol, 176: 296, 2006
Luo, C. C., Lin, J. N., Chiu, C. H. et al.: Use of parenteral testosterone prior to hypospadias surgery. Pediatr Surg Int, 19: 82, 2003
Timing of elective surgery on the genitalia of male children with particular reference to the risks, benefits, and psychological effects of surgery and anesthesia. American Academy of Pediatrics. Pediatrics, 97: 590, 1996
Cote, C. J., Zaslavsky, A., Downes, J. J. et al.: Postoperative apnea in former preterm infants after inguinal herniorrhaphy. A combined analysis. Anesthesiology, 82: 809, 1995
Cook, A., Khoury, A. E., Neville, C. et al.: A multicenter evaluation of technical preferences for primary hypospadias repair. J Urol, 174: 2354, 2005
Snodgrass, W. T., Koyle, M. A., Baskin, L. S. et al.: Foreskin preservation in penile surgery. J Urol, 176: 711, 2006
Nguyen, M. T., Snodgrass, W. T.: Effect of urethral plate characteristics on tubularized incised plate urethroplasty. J Urol, 171: 1260, 2004
Baskin, L. S., Duckett, J. W., Ueoka, K. et al.: Changing concepts of hypospadias curvature lead to more onlay island flap procedures. J Urol, 151: 191, 1994
Baskin, L. S., Erol, A., Li, Y. W. et al.: Anatomical studies of hypospadias. J Urol, 160: 1108, 1998
Kajbafzadeh, A. M., Arshadi, H., Payabvash, S. et al.: Proximal hypospadias with severe chordee: single stage repair using corporeal tunica vaginalis free graft. J Urol, 178: 1036, 2007
Bhat, A.: Extended urethral mobilization in incised plate urethroplasty for severe hypospadias: a variation in technique to improve chordee correction. J Urol, 178: 1031, 2007
Nguyen, M. T., Snodgrass, W. T.: Tubularized incised plate hypospadias reoperation. J Urol, 171: 2404, 2004
Schwentner, C., Gozzi, C., Lunacek, A. et al.: Interim outcome of the single stage dorsal inlay skin graft for complex hypospadias reoperations. J Urol, 175: 1872, 2006
Snodgrass, W., Elmore, J.: Initial experience with staged buccal graft (Bracka) hypospadias reoperations. J Urol, 172: 1720, 2004
Lam, P. N., Greenfield, S. P., Williot, P.: 2-stage repair in infancy for severe hypospadias with chordee: long-term results after puberty. J Urol, 174: 1567, 2005
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Snodgrass, W.T. (2011). Hypospadias. In: Palmer, J. (eds) Pediatric Urology. Current Clinical Urology. Humana Press. https://doi.org/10.1007/978-1-60327-420-3_9
Download citation
DOI: https://doi.org/10.1007/978-1-60327-420-3_9
Published:
Publisher Name: Humana Press
Print ISBN: 978-1-60327-419-7
Online ISBN: 978-1-60327-420-3
eBook Packages: MedicineMedicine (R0)