COMPANY LOGO www themegallery c om HYPOSPADIAS Jabbari

COMPANY LOGO www. themegallery. c om

HYPOSPADIAS Jabbari A

ETIOLOGY ØHypospadias is believed to result from arrested penile development, leaving a proximal urethral meatus. ØThe underlying cause for nonsyndromic hypospadias in most individual cases is unknown.

Risk factors Ø Placental dysfunction Ø Low birth weight, preterm birth, maternal obesity and diabetes, and maternal hypertension. Ø Maternal age (<24 years) and (>40 years) Ø Assisted reproduction Ø Paternal subfertility Ø Twin pregnancy.

DIAGNOSIS Ø Hypospadias is diagnosed by physical examination, first suspected by the ventrally deficient prepuce and confirmed by the proximal meatus Ø Other abnormal findings include downward glans, deviation of the median penile raphe, VC, and penoscrotal transposition.

COMPANY LOGO www. themegallery. c om

ASSOCIATED ANOMALIES Ø Cryptorchidism Ø Prostatic Utricle Ø Disorders of Sex Development COMPANY LOGO www. themegallery. c om

TIMING OF SURGERY Ø Best time is between 6 and 12 months Ø From 18 months to approximately 3 years of age has been described as a difficult period for hospitalization, leading to a recommendation that repair be postponed to age greater than 3 years COMPANY LOGO www. themegallery. c om

PREOPERATIVE HORMONAL STIMULATION Ø Androgenic stimulation has been advocated to increase penile size, reduce VC, and improve vascularity. Ø Two to three intramuscular injections of testosterone enanthate 2 mg/kg over a 6 - to 12 -week period. Ø Reported mean increases in penile length range from approximately 0. 5 to nearly 3 cm, with partial to complete loss of these gains by 3 to 12 months after stimulation COMPANY LOGO www. themegallery. c om

SURGICAL TECHNICS • • TIP MAGPI Mateu Flaps: - Byars flap - Koyanagi flap - Tubularized preputial flap - Tunica vaginalis barrier flap • Grafts: - Preputial Grafts COMPANY LOGO www. themegallery. c om

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