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Hypospadias

• Summary
• Introduction
• Differential Diagnosis
• Investigation
• Management
• References

Summary

• no immediate management is necessary as long as the testes are descended and there is a good urinary stream
• all cases should be referred to a paediatric surgeon

Introduction

Hypospadias is a common condition which affects 1 in 300 newborn males.  It is more common in growth retrictred males.

The clinical findings in hypospadias are as follows

• the urethra opens on the ventral surface of the penis and does not reach the tip of the glans. In mild cases the meatus is at the base of the glans. In severe cases the urinary meatus may open in the scrotum or perineum
• the prepuce lacks ventral tissue so is hooded
• all but the mildest cases involve some degree of chordee. Chordee is a lack of ventral tissue on the penis leading to a bowstring effect causing longitudinal bending of the shaft

Differential Diagnosis

If present with undescended testes an intersex disorder should be considered. Gender assignment should be delayed until the sex of rearing has been decided. Urgent expert assessment is required (see section on management of ambiguous genitalia).

Investigation

Careful examination is required since hypospadias is associated with a large number of other anomalies and syndromes.

Infants with penoscrotal or perineal abnormalities should be assessed to exclude intersex disorders.(see section on management of ambiguous genitalia).

Management

• no immediate management is required as long as the meatus is not stenosed and there is a good urinary stream
• the parents should be advised not to circumcise the child as the prepuce is sometimes used in reconstructive surgery
• referral should be made to a paediatric surgeon. To reduce the psychological impact surgical correction is usually performed in infancy, if possible, as a one-stage procedure. Occasionally surgery is not required. If a chordee is present surgical correction is required because when standing there will be difficulty with directing urinary stream. Intercourse may also be difficult or painful because the chordee is accentuated during an erection

References

Hutson, J.M., Woodward, A.A., and Beaseley, S.W. (editors). Jones’ Clinical Paediatric Surgery. 5^th edition. Blackwell Science Pty Ltd. 1999.

Smart, J. (editor). Paediatric Handbook. 6^th edition. Blackwell Science Pty Ltd. 2000.

Balfour-Lynn, I.M. and Valman, H.B.V. Practical Management of the Newborn. 5^th edition. Blackwell Science Pty Ltd. 1993.

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