Hypospadias

Hypospadias is considered the result of arrested development, leaving incomplete urethral formation sometimes associated with ventral penile curvature. The minority of cases occurring with other syndromes, or when there is also undescended testis, warrant a preoperative karyotype to detect intersex disorders. Otherwise the only preoperative evaluation needed is assessment of glans size, as there may be benefit from preoperative testosterone therapy to increase glans diameter, usually in proximal hypospadias. Today most primary cases are corrected by tubularizing the urethral plate tissue that should have originally created the urethra when development stopped. Prepucial flaps remain an option for repair, as do planned 2-stage flap or graft procedures. The majority of hypospadias complications relate to urethroplasty, most commonly including fistulas, obstruction to the neourethra (by meatal stenosis or urethral stricture), or wound dehiscence. Incidence varies by technique used and extent of the hypospadias defect (distal versus proximal). Reoperative urethroplasty can be accomplished using similar methods as for primary surgery, but complication rates are greater. At times excision of scarred tissues with planned 2-stage graft repairs is required to re-create a neourethral plate to subsequently tubularize.