Hypospadias in children

Hypospadias is a congenital defect of the penis, which associates three abnormalities in penile anatomy and development: an abnormal ventral opening of the urethral meatus, which may be located anywhere between the ventral part of the glans penis and the penis, an abnormal ventral curvature of the penis (chordee), and an abnormal distribution of the foreskin, with redundant dorsal skin and deficient foreskin on the ventral side.

Symptoms of hypospadias

Clinically hypospadias causes no symptoms, and is not associated with an increased rate of urinary tract infection. Patients with hypospadias may present with infertility secondary to abnormal semen elimination due to the anomalous location of the meatus and associated penile incurvation.

Causes of hypospadias

Hypospadias is caused by any of the following:

  • Tubulization stops in some sector, from which the ectopic meatus originates.
  • Lack of union between the glandular and penile urethra.
  • The penile curvature would thus be explained by an abnormal development of the urethral plate. The appearance of abnormal fibrous mesenchymal tissue in the urethral meatus a differentiated abnormal growth of tissue of the corpora cavernosa normal in the dorsal part and abnormal in the ventral part.
  • The lack of union of the ectodermal folds would be the cause of the dorsal redundant foreskin.

It is estimated that there is a multifactorial etiology: an environmental or endocrine disrupting factor, an innate enzymatic or endocrine tissue abnormality, together with a manifestation of developmental arrest.

However, in most cases of hypospadias the etiology of the disease is unknown, and only in a small percentage of patients can it be explained by abnormal androgen metabolism.

Evaluation of the severity of hypospadias

The physical examination to be performed by the pediatric urologist will evaluate the following:

  • Location of the uterine meatus and the appearance of the glans penis. According to the position of the meatus, hypospadias is classified as distal (meatus located in the balanic, coronal and subcoronal region), middle (meatus on the penis) and proximal (penoscrotal, scrotal or perineal meatus).
  • Assessment of whether or not the meatus is stenotic and whether or not it has an elongated or tapered appearance, or has a subepidermal cleft.
  • Assess whether or not there is penile incurvation, either by pulling the penile skin towards the root or by asking the parents what the penis looks like when spontaneous erections occur.
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Treatment of hypospadias

Without remedy, the final treatment for hypospadias is surgical. Thus, there are a number of goals that will be attempted to be achieved in order to consider the hypospadias repair to have been successful.

  • Creation of a normal sized urethral meatus and glans penis.
  • Formation of a straight penis
  • Normal urethra from its origin to its end.
  • Skin coverage
  • Normal position of the scrotum in relation to the penis.

Hypospadias repair is recommended when the baby reaches 18 months of age. Most of these can be repaired at once, but there are more severe cases in which the repair will consist of several stages.

The first stage consists of straightening the penis and removing the excess skin from the dorsal foreskin to the ventral side, in order to make a future urethral plate. The second stage consists of the reconstruction of the new urethra, glans penis and skin cover.

For more information, consult a specialist in Pediatric Urology.