1 / 20

HYPOSPADIAS

HYPOSPADIAS. Dr.GOVINDRAJAN Department of Urology and Renal Transplantation SRMC & RI. NORMAL PENILE ANATOMY. 2 Corpora Cavernosa, Corpus Spongiosum Enclosed In A Fascial Sheath- T.Albuginea Bucks Fascia, Thick Fibrous Envelope Connective Tissue, Dartos Fascia. HYPOSPADIAS.

Anita
Download Presentation

HYPOSPADIAS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. HYPOSPADIAS Dr.GOVINDRAJAN Department of Urology and Renal Transplantation SRMC & RI

  2. NORMAL PENILE ANATOMY • 2 Corpora Cavernosa, Corpus Spongiosum Enclosed In A Fascial Sheath- T.Albuginea • Bucks Fascia, Thick Fibrous Envelope • Connective Tissue, Dartos Fascia

  3. HYPOSPADIAS • Hypo- below, Spadon- orifice • Urethral meatus opens on ventral side of the penis, proximal to the tip of glans penis • Incidence ……..1/125 to 1/250

  4. EMBRYOLOGY • Cloacal membrane, genital tubercle, labioscrotal swellings • Androgen stimulation…phallus elongation • 3 phases of urethral formation • Posterior urethra formation • Anterior urethra formation • Glandular segment formation • Prepuce formation

  5. CLASSIFICATION • Smith …….. • Able ……..I , II, III degree • Browne ……..Coronal - distal penile, proximal penile, penoscrotal, scrotal penile • Basrat …….. (post chordee release)

  6. CLASSIFICATION (LOCATION) • DISTAL • Glandular, Coronal, Distal penile • MIDPENILE • Midshaft • PROXIMAL • Proximal penile, Penoscrotal, Scrotal, Perineal

  7. ASSOSIATION WITH OTHER DEFECTS • Renal agenesis, dysplasia, reflux • Prostatic utricle • Hernia : 9% • Cryptorchidism : 9% • Father : 9% • Siblings : 14%

  8. PARTS OF HYPOSPADIAS • Meatus … usually non-stenotic • Stenosis more common in distal hypospadias • Megalomeatus intact prepuce

  9. SKIN….. • Ventral defect & dorsal hood • Urethral delta • Hood of monk….Cobra eyes • Defects of spongiosum • Defects of cavernosa • Defective urethral plate

  10. CURVATURE • Skin attachments • Bucks defect • Urethral plate • Cavernosa defects • Problems of unhealthy urethra

  11. CHORDEE WITHOUT HYPOSPADIAS • Primary penile curvature • Types • Without defects (2/3) • With defects (1/3) • Penile torsion • Deviation to left • Concealed hypospadias

  12. DEVINE HORTON CLASSIFICATION • TYPE I : • SPONGIOSUM DEFECT • TYPE II : • BUCKS & DARTOS DEFECT • TYPE III : • DARTOS & SKIN DEFECT

  13. HYPOSPADIAS & INTERSEX • ? Form of androgen insufficiency • Mixed gonadal dysgenesis • Androgen insensitivity • Testosterone synthesis defects • 5 alpha reductase defects

  14. FEATURES OF REPAIR • Artificial erection ( Gittes & McLaughlin) • Meatal correction • Neourethral formation • Orthoplasty • Skin cover…. Neourethral cover • Dorsal prepuce : Tunica Vaginalis • Time of repair : 6months - 12months

  15. CORRECTION OF CHORDEE AFTER ORTHOPLASTY • Nesbitt plication • T.A.P • Dermal graft • T.Vaginalis graft • Corporal resection

  16. HCG BEFORE SURGERY • Increase in penile length • Meatal advancement by 5-20mm • Decrease in hypospadias • Decrease in chordee • Increased vascularity • Increased corporal thickness both proximal & distal

  17. TREATMENT OPTIONS • GLANDULAR & SUBCORONAL • MAGPI • GAP • MIP • DISTAL PENILE • MATHEIU • SNODGRASS • DEVINE HORTAN • MUSTARDEE

  18. TREATMENT OPTIONS… • MIDPENILE • SNODGRASS • ONLAY ISLAND PREPUTIAL FLAP • KING • HODGSON II • PROXIMAL PENILE • TRANSVERSE PREPUTIAL FLAP • HODGSON I • HODGSON III

  19. TREATMENT OPTIONS… • POSTERIOR URETHRA • TRANSVERSE PREPUTIAL FLAP • TWO STAGED • BUCCAL….TUBULAR….GLANS CHANNEL • BAYRS… • CECIL • SMITH

  20. COMPLICATIONS • BLEEDING & HEMATOMA • MEATAL STENOSIS • URETHROCUTANEOUS INFECTION • URETHRAL DIVERTICULA • RECURRENT CURVATURE / STRICTURE • BREAK DOWN

More Related