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Hypospadias - Coggle Diagram
Hypospadias
Treatment
The current recommendation is to complete hypospadias repair before 18 months of age to minimize the psychological impact of genital surgery.
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Urethroplasty:
Techniques include advancement (e.g., MAGPI), tubularization (e.g., Snodgrass), and local tissue flaps (e.g., Mathieu's perimeatal-based flap).
Two-Stage Urethroplasty:
Utilizes local or extragenital free grafts (e.g., preputial skin, buccal mucosa) for severe hypospadias with significant chordee.
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Skin Coverage:
Achieved by ventral transfer of preputial skin, often resembling a circumcision.
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CF
Meatal Abnormalities:
The urethral meatus may be located slightly ventrally, just below a blind dimple, or it may be more proximal, even in the perineum.
Meatus configurations vary in form, diameter, elasticity, and rigidity.
Penile Curvature:
Penile curvature results from a deficiency of normal structures on the ventral side of the penis, caused by skin deficiency, dartos fascial deficiency, true fibrous chordee, or deficiency of the corpora cavernosa.
Skin Abnormalities:
Distal to the meatus, there is often a paucity of ventral skin, contributing to penile curvature and dorsally hooded foreskin.
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Associated abnormaltiy
Undescended testis and inguinal hernia are common anomalies associated with hypospadias, occurring in 7-13% of patients.
Severe hypospadias may be associated with renal malformations like hydronephrosis, vesicoureteral reflux (VUR), and renal agenesis.
Other minor penile anomalies that may accompany hypospadias include torsion of the penis, concealed penis, webbed penis, and penoscrotal transposition.
Definition
Hypospadias is a complex condition characterized by an abnormal ventral meatus, chordee, and a dorsal hooded foreskin.
Embryology
The development of the male urethra occurs between the 8th and 15th weeks of gestation under the influence of testosterone.
Formation of the posterior urethra with advancement to the developing phallus as the urethral groove.
Ventral fusion of urethral folds, completed distally by the in-growth of ectoderm from the tip of the glans.
Incidence
The incidence is approximately 1 in 300 boys and varies between 0.4 - 8.2 per 1,000 newborn boys in different populations.
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