Nowadays the aesthetic result has nearly the same relevance as the functional outcome, the strategies and objectives have refined the hypospadias correction technique further and the concept of hypospadiologist was coined by Duckett in1995. Because it is a complex plastic and reconstructive procedure, we have dedicated team which have plastic and reconstructive surgeon and a paediatric surgeon, along with dedicated anaesthesiologist with rest of our team who are willing to give services at every time day and night. We have good operation theatre setup, which have more advance instruments for hypospadias repair mostly under magnification.INCIDENCE / FREQUENCY
The incidence of hypospadias has been reported to be anywhere between 1in 250 to 1 in 350 newborn boys. The large differences in frequency have their origin in geographical, genetic and environmental influences. The incidence of hypospadias is increasing the reasons are not yet clearly understood, but this may be due to more awareness or more cases referred to centres.ETIOLOGY / CAUSES
In most cases, the cause of this birth defect is not fully understood. The etiology of hypospadias is multifactorial. In two third of hypospadias the cause remains unknown. Sometimes hypospadias is inherited. Genetic factors are likely involved in at least some cases. The probability – 8% have affected fathers, and 14% have affected brothers. There may also be an increased risk of hypospadias in infant males born to women of an advanced age or those who used in vitro fertilization (IVF) to conceive, may be due to the mother’s exposure to progesterone.RISK FACTORS
There is an increased risk for the occurrence of hypospadias, common risk factors are –
- Father with hypospadias
- Low birth weight
- Twin or triplet births
- Iron supplement during pregnancy
- Smoking mothers
- Fathers with pesticide contact
- Pregnancy through artificial insemination or medical support
(Treatment with hormones such as progesterone during pregnancy may increase the risk of hypospadias).
Hypospadias is caused by the arrest of normal development of the urethra. Prenatal testosterone is converted in the genital skin to dihydrotestosterone causes migration of skin fibroblasts to fully enclose the urethral groove in fetal males, normally resulting in an enclosed penile urethra by the second trimester of pregnancy or in other words 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. Failure of adequate prenatal androgen (may be that transient deficiency) effect is therefore thought to be involved in many cases, making severe hypospadias a very mild form of intersex. However, deficiency or abnormality of testosterone, dihydrotestosterone or 5-α reductase is not commonly found in hypospadias alone, so aetiology is multifactorial process which links with hormone, genetic and environmental factors.
The penile shaft curvature or chordee can occur due to several causes:
- Abnormal development of urethral plate.
- Abnormal fibrotic mesenchymal tissue at the urethral meatus.
- Corporal disproportion or differential growth of normal dorsal
- Corpora cavernosum and abnormal corporal tissue ventrally.