It is the most common congenital anomaly of the penis. The term was introduced by Galen.
It is the most common congenital anomaly of the penis. The term was introduced by Galen.
The formation of the external genitalia is completed by the 4th month of pregnancy. The testicles emerge into the scrotum in the 7th month.
Hypospadias consists of incomplete development of the anterior urethra, with ectopic position of its external orifice. It is usually accompanied by flexion of the penis due to ‘stringing’ (fibrous connective tissue), which is a degenerative remnant of the undeveloped part of the urethra. It is a form of incomplete genital masculinisation, probably due to insufficient production of testicular hormones.
It occurs at a rate of 1:350 births in the United States. It presents a diversity in its clinical presentation. The most common forms are valanian and anterior pelvic hypoplasia. It is occasionally accompanied by cryptorchidism. More rarely, the genitalia may be hypoplastic and so much so that sex determination is not easy (eudermaphroditism). Perhaps this is why Galen coined the term hypospadias, from “sword” meaning, “eunuch”.
Its treatment has always been of interest to surgeons. This is evidenced by the over 200 correction techniques that have been described. The aim is a) to straighten the penis by removing the chord & b) to restore the urethra by placing its external orifice in the correct position (urethroplasty).
Timing: the operation should be performed in the first year of age.
Single-stage techniques are now the surgeons’ preference.
