Hypospadias repair

Abstract

Hypospadias represents a maldevelopment of the ventrum of the penis (Fig. 41.1). In its fullest form, the urethra, glans, corpora cavernosa, subcutaneous tissues, and skin are all involved. But each case is unique, and some penile elements may be more or less affected in any given case. The urethral anomaly is most obviously expressed in the ectopic urethral meatus located anywhere from the perineum to the proximal glans. But the spongy covering of the urethra may also be abnormal proximal to the meatus. Typically, the spongy tissue covers the proximal urethra, but splits somewhere proximal to the meatus and lies on either side of the urethral plate converging with the glans distally. This leaves a thin uncovered portion of urethra, which may be only a few millimeters long or may extend quite proximal to the hypospadiac meatus. In most cases of hypospadias, the glans is flattened, reflecting the divergent spongiosa distally. The foreskin is incomplete in 95% of cases, being deficient ventrally; the ventral penile skin is often thin and short, tethering the penis and contributing to the frequently seen ventral chordee. Dense fibrous subcutaneous tissue - chordee tissue - may also contribute to this ventral curvature. In more severe cases of ventral chordee, the corpora cavernosa themselves may be bent due to a deficiency and subsequent shortening of the ventral sides. Hypospadias repair involves addressing each of these issues sequentially in each case. © 2006 Humana Press Inc.