FOR DOCTORS – PART I

Professor Hadidi hypospadias surgery

FOR DOCTORS – PART I

Incidence

One in 125 boys has hypospadias. In the United States a study reported that hypospadias was the most common congenital anomaly among whites. The incidence has been rising during the 1970s and 1980s.

Classification

Anatomic classification of hypospadias recognizes the level of the meatus without taking into account curvature. A more recent classification was described. This classification indicates the site of urethral meatus (before and after chordee correction), the prepuce (incomplete or complete), the glans (cleft, incomplete cleft or flat), the width of urethral plate, the degree of penile rotation if present and the presence of scrotal transposition (Fig. 1, 2). Using the general classification (Fig. 4), surgeons are able to conduct multi-centre studies to evaluate different techniques of repair.

Fig. 1: Classifications of hypospadias, according to location of meatus into 4 grades


Fig. 2 a – c: Classification of glans configuration in hypospadias.

      a. Cleft glans. There is a deep groove in the middle of the glans with proper clefting; the urethral plate is narrow and projects to the tip of the glans.
      b. (b) Incomplete cleft glans. There is a variable degree of glans split, a shallow glanular groove and a variable degree of urethral plate projection.
      c.  Flat glans. The urethral plate ends short of the glans penis, no glanular groove. There may be a variable degree of chordee, especially in proximal forms of hypospadias.


Fig. 3: Evaluation of risk for hypospadias repair from birth to age 7 years. The optimal window is from 3 to 18 months of age (modified from Schulz et al. 1983).


 

Fig. 4: General classification: surgeons are able to conduct multi-centre studies to evaluate different techniques of repair