PROF ANTONIO RUFFO
Specialist in Urology
Andrology Genital and Urethral Recostructive Surgery
mobile +39 3511718896
Hypospadias
Hypospadias is a congenital condition of the penis characterized by a series of modifications to the external male genitalia.
The urethral meatus (the opening from which urine exits) is not located in its normal anatomical position but rather at any point on the ventral surface of the penis.
Developmental anomalies are also evident in other penile structures: the ventral portion of the tunica albuginea, the external penile fascia (Dartos), and the skin form a "cord" that causes a downward curvature of the penis.
Additionally, there is an associated defect in the formation of the foreskin, known as a 'friar's cap.'
It is one of the most common congenital anomalies in males, with an incidence of approximately 1 in 250 live births.
The etiopathogenesis of the condition is multifactorial: there is both a genetic component, leading to a predisposition to the disease in male offspring of affected parents, and a hormonal component during embryogenesis. Scientific studies have observed a premature drop in testosterone levels, resulting in incomplete development of the urethral canal.
How does it present?
Hypospadias is characterized by an abnormal opening of the urethra, with its external meatus located, depending on the severity, at varying distances from the apex of the glans, in a ventral position.
The foreskin covers only the dorsal and lateral aspects of the glans (preputial apron), and the preputial frenulum is absent.
Are there different forms of hypospadias?
Yes, in the literature, we distinguish:
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Anterior or distal hypospadias (80% of cases)
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Middle hypospadias (15% of cases)
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Posterior or proximal hypospadias (5% of cases), with the hypospadiac meatus located at the level of the penile base, scrotum, or perineum.
What are the symptoms of hypospadias?
The symptoms are closely related to the severity of the malformations and range from mild modifications of the aesthetic appearance of the foreskin and glans in balanic or distal forms, to the inability to urinate in a normal position, resulting in potentially severe psychological complications. "Impotentia generandi" may occur due to the too external deposition of semen, and "impotentia coeundi" in cases with significant curvature that makes penetration difficult or impossible.
The goal of hypospadias treatment is to ensure not only normal urination and erections but also a penis with morphology as close to normal as possible, featuring a well-reconstructed meatus and glans.
It is advisable to intervene as early as possible in cases where sufficient development of the penile organ has been achieved (between 3 and 5 years old). This is done to avoid psychological issues in the child and, most importantly, to release the fibrous cord from the cavernous bodies, allowing for the normal development of the shaft.
The urologist-andrologist, among the various techniques available, will choose the "ideal" one to provide the patient with the best benefits. The surgery in children is performed under general anesthesia, and hospitalization is usually limited to one or two days.
The intervention can be done in one or two stages, depending on the type of hypospadias.
Are there complications in the postoperative period?
The most frequent complications observed in the literature consist of the formation of fistulas and stenosis of the meatus. Both issues largely stem from the technique used and the subsequent wound management after the surgical intervention.
Much more rarely, other complications such as ectropion, balanitis xerotica obliterans, urethrocele, and the growth of hair in the neourethra can occur when using scrotal skin flaps.
