Hypospadias

Abstract

Hypospadias is one of the most common congenital anomalies in men. It is a complex of an abortive development of the urethral spongiosum with an abnormal ectopic meatus, the ventral prepuce with dorsal hood, and in more severe cases penile chordee. It is formed by a failure of fusion of the urethral folds ventrally and its etiology is multifactorial involving genetic, endocrine, and environmental factors. It is seen usually as an isolated anomaly but known to be associated with persistent utricle, inguinal hernia/hydrocele, and undescended testis and it can be part of the disorders of sexual differentiation (DSD) spectrum. Average incidence is 1 in 300 live-births with rising incidence in the last three decades mainly seen with increasing parity, increasing maternal age, and reduced birth weight. Types of hypospadias is based on the location of the ectopic meatus. Ideal age of repair is between 6 and 18 months. Infants with hypospadias should not undergo circumcision. There are several techniques of hypospadias repair but the most commonly performed procedures are meatal advancement with glanuloplasty incorporated (MAGPI) and Snodgrass tabularized incised plate (TIP) technique for distal hypospadias and Bracka two-staged repair for more proximal hypospadias with chordee. The major technical advances in hypospadias surgery that have improved surgical outcomes include preservation of the urethral plate, incision of the urethral plate, dorsal midline plication, de-epithelized urethroplasty dartos flap coverage, and two-stage alternative techniques. It has long-term complications and patients should be followed.