Hypospadias

The hypospadiac genital tubercle (GT) is the consequence of a development arrest of the tissues forming its ventral aspect, which occurs during the “masculinization window” (6–16 weeks of gestation). The causes of this common congenital malformation are essentially unknown and probably multifactorial. Four main factors may be responsible for hypospadias: (1) the child’s genes and hormonal system; (2) the placenta, which plays an essential role during the masculinization window; (3) the mother; and (4) the environment, with its potential hormonal disruptors. Assessment of the hypospadiac GT is a crucial step to explore the causes and plan surgery which, in some cases, can be preceded by hormonal stimulation. Surgery entails three main steps: (1) degloving the GT to identify the level of division of the corpus spongiosum, which is the main criteria to define hypospadias severity, i.e., the degree of dysplasia of the ventral tissues and consequently the degree of ventral curvature; (2) choosing the adequate technique of urethroplasty which is dependent on the quality of the urethral plate, the availability of preputial tissue, the length of urethra to be reconstructed, the size of the glans and depth of the glans groove; and (3) covering the straightened GT with a redistribution of the penile skin. Evaluation of the outcome is another critical step in this management and includes functional and cosmetic results until adulthood. One essential characteristic of pediatric urology/surgery is that reconstructions are performed on growing organs.