Hypospadias Surgery at Cosmo Aid Clinic Kolkata by Dr. Anand Nagwani

Hypospadias Surgery


Feedback after Hypospadias Surgery



Presentation on Hypospadias Surgery

Before


After



Before


After



Before


After



Before


After



Etiology & Pathophysiology

The condition is thought to be caused by under-stimulation of the genital tubercle and penis by dihydrotestosterone, resulting in failed fusion of the urogenital folds. However, deficiency or abnormality of testosterone, dihydrotestosterone or 5-α reductase is not commonly found in hypospadias alone. Direct aetiology is unknown in most cases and it appears to be a multifactorial process with links made to hormonal changes, genetic sus-ceptibility and environmental factors.Female sex hormones have been implicated and the ever increasing use of oestrogens has been suggested as a possible cause for the recent rise in incidence. In addition it is five times more common in boys born from IVF – possibly due to the effects of materal progesterone on 5-alpha reductase.

Monozygotic twins have an 8 times increased risk of hypospadias compared to single-tons. This may be due to in-utero competition for HCG. In some cases there also appears to be a genetic link. Of affected boys, 8% have affected fathers and 14% have affected brothers. If two family members are affected, the risk for a subsequent boy is 22%

Presentation

The prominent presenting feature of hypospadias is the abnormal urethral opening. The external urethral meatus or opening is present on under surface of penis anywhere from the glans, shaft of the penis, to scrotum or perineum. Parents are usually complaints of soiling of cloths during urination. The foreskin looks abnormal (hooded prepuce). The penis is curved (chordee). Urinary stream is narrow (due to pin hole meatus or opening). Sometimes present with due to other anomalies like inguinal hernias and undescended testes.

Indication

Indication of treatment is functional, social, and cosmetic.

Functional

  • urinary stream is not straight/spray of urine/soiling of cloths

  • sexual gratification and or infertly(due to functional region) in adult life


Social

  • Male child has difficulty in urination in standing position, if he does than his cloths become soil.


Cosmetic

  • Hypospadias is a congenital abnormality of the male external genitalia wherein the external urethral meatus is found to be abnormal position, may be on the shaft of the penis, the scrotum or the perineum.

  • This is accompanied by abnormal curvature of the penis in around 15% of cases, inguinal hernias in 9% of cases and undescended testes in 9% of cases


Relevant Anatomy of penis

The two corpora cavernosa and the corpus spongiosum of the urethra with the glans form the penis.

These structures are made from erectile tissue surrounded by the tunica albuginea (Buck fascia) and by the dartos fascia more superficially, which contains terminal branches of external pudendal arteries and veins, pudendal nerves, and the superficial lymphatics.

Transverse section of the penis at midshaft level. From outside, the dartos fascia is visible with the blood vessels, the tunica albuginea surrounding the corpora cavernosa, and, in a ventral position, the urethra surrounded by its erectile tissue.

The normal male urethra runs from the bladder through the penile shaft, ventrally to the corpora cavernosa, and sorts with the external urethral meatus at the tip of the glans.

Contraindications

" RELATIVELY NO CONTRAINDICATION "

There is no such contraindications in Hypospadias. Rather It’s much fruitful for the Patients who are suffer from these disease to consult to the doctor for a surgery.

Case History

The diagnosis of hypospadias has been made with both antenatal fetal ultrasonography , the diagnosis is generally made upon examination of the newborn infant.

A dorsal hood of foreskin and glandular groove are evident, but upon closer inspection, the prepuce is incomplete ventrally and the urethral meatus is noted in a proximally ectopic position. Rarely, the foreskin may be complete, and the hypospadias is revealed at the time of circumcision.

If hypospadias is encountered during neonatal circumcision, after the dorsal slit has been performed, the procedure should be halted, and the patient should be referred for urologic evaluation.

Proximal hypospadias is commonly associated with a bifid scrotum and penoscrotal transposition which the rugated scrotal skin begins lateral to the penis rather than in its normal posterior origin.

Diagnosis

Traditionally, the diagnosis is made at the time of birth by physical examination. Recent advances in prenatal diagnosis have allowed obstetricians to diagnose facial clefts in utero with ultrasonography. Clefts can also affect other parts of the face, such as the eyes, ears, nose, cheeks, and forehead.

Investigation

  • Blood Investigation

  • Complete Blood Count

  • Blood Group

  • Blood Urea

  • S. Creatinine

  • Bleeding Time

  • Cloting Time

  • Prothrombin Time

  • Blood Sugar -(F)

  • ECG

  • Chest X-Ray Pa View

  • Ultra Sound Of Whole Abdomen Including Ilioinguinal Region


Online Appointment