Hypospadias
Case report
Prepared by:
Sara Mustafa Hamza
Under supervision of:
Dr. Amal Ahmed El-Belgahy
Hypospadias
Case report
1) sociodemographic data: Patient name:
Abdel-hamed Mohmed Abdel-hamed
Age:
8 years
Sex:
Male
Diagnosis:
hypospadias (glandular)
Date of admission: 2/8/2017
Unit:
surgical
Room number
4
Bed number
3
2) patient history: Abdel-hamed 8 years old pt. diagnosed as hypospadias by her
mother obstetrician physician at birth. not circumcised at birth as
doctor advice. have surgical repair at MUCH in 20/12/2016 and
during his follow up visit her mother repot to the doctor that she
notices leakage of urine from other opening rather than meatus
related to infection
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and with examination doctor found fistula .and pus drainage
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Present history:
Post-operative pt. with urinary catheter
Growth Measurement:
Weight:
Height:
HC:
CC:
25 kg
126 cm
53 cm
66 cm
Medication:
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2
Unacin
vial
1/3
antibiotic
Claveran
vial
1/2
antibiotic
Brufen
syrup
1/3
antipyretic
Hypospadias
 Hypospadias is a birth defect (congenital condition) in which the opening
of the urethra is on the underside of the penis instead of at the tip.
 The urethra is the tube through which urine drains from your bladder and
exits your body.

It’s the most common anomaly of male urethra in which the external
urethral meatus is located in the ventral surface of the penis with curving
of penis ventrally by cord called chordee.
 Hypo- below, Spadon- orifice
 Urethral meatus opens on ventral side of the penis, proximal to the tip of
glans penis
 Incidence: 1/300
Pathophysiology:
Failure of canalization of certain part of the distal urethra which is replaced
by fibrous tissue called chordee
Classification (Location):
1. DISTAL: Glandular, Coronal, Distal penile
3. PROXIMAL: Proximal penile, Pen scrotal, Scrotal, Perineal
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2. MIDPENILE: Midshaft
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Causes:
In most cases, the exact cause of hypospadias is unknown. Sometimes,
hypospadias is genetic, but environment also may play a role.
Risk factors:
1. Family history.
2. Genetics. Certain gene variations may play a role in disruption of
the hormones that stimulate formation of the male genitals.
3. Maternal age over 35.
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4. Exposure to certain substances during pregnancy. There is some
speculation about an association between hypospadias and a
mother's exposure to certain hormones or certain compounds such
as pesticides or industrial chemicals, but further studies are needed
to confirm this.
Clinical picture:
1. Opening of the urethra at a location other than the tip of the penis
2. Downward curve of the penis (chordee)
3. Hooded appearance of the penis because only the top half of the
penis is covered by foreskin
4. Abnormal spraying during urination (disturbed act of micturition)
5. Sever dermatitis
In sever degree of anomaly (penial hypospadias) the penis is severely
curved resembling clitoris and the scrotum is bifid resembling the labia
majora leading to ambiguity
Diagnosis:
Most infants with hypospadias are diagnosed soon after birth by physical
examination.
Complications
1. Abnormal appearance of the penis (psychological problem)
2. Lack of personal hygiene
3. Acute or chronic retention of urine
4. Problems learning to use a toilet
5. Abnormal curvature of the penis with erection (infertility)
Treatment:
1. The problem of hypospadias should be completely solved before school
age.
2. Circumcision should not be done.
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6. Problems with impaired ejaculation
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3. Most forms of hypospadias can be corrected in a single surgery.
4. Some forms of hypospadias will require more than one surgery to correct
the defect.
5. When the urethral opening is near the base of the penis, the surgeon may
need to use tissue grafts from the foreskin or from the inside of the
mouth to reconstruct the urinary channel in the proper position, correcting
the hypospadias.
Results of surgery:
 In most cases, surgery is highly successful. Most of the time the penis looks
normal after surgery, and boys have normal urination and reproduction.
 Occasionally, a hole (fistula) develops along the underside of the penis
where the new urinary channel was created and results in urine leakage.
Rarely, there is a problem with wound healing or scarring. These
complications may require an additional surgery for repair.
Preoperative instructions for children and adult undergoing
hypospadias repair:
1. Empty stomach before surgery
2. Bathing
3. Consent before anesthesia and surgery
4. Hospital Clothes
5. Sedation before surgery
Post-Operative Instructions for Hypospadias Repair:
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 Children who undergo hypospadias repair are usually discharged from the
hospital the same day as the surgery.
 Catheter:
• Your child may be discharged with a catheter. If your child wears a
diaper, the catheter will drain into his diaper.
• If your child is older, the catheter will drain into a bag on his leg.
Urine may leak around the tube or spurt through the tube.
• Excessive leaking might indicate the tube is blocked. If you suspect
this, or if the tube comes out, call Pediatric Urology.
 Medications:
• Continue to give the antibiotic for several days after the removal of
the catheter
 Dressings
• Your son will go home with a "dressing" or covering consisting of a
plain gauze taped around his penis.
• It may become soiled and loose from urine and stool.
• If the dressing is covered with stool, clean with soapy water, wiping
toward the rectum and away from your child's penis.
• Remove the dressing two days after your son's surgery.
• This can be done easily in the bath.
 Bathing:
 Sponge-bathe your child until the dressing is removed.
 You can give your son tub baths when the dressing falls off or two
days after the surgery.
 Your child can take a tub bath even while the catheter is in. When you
resume regular bathing:
 Don't scrub the area and don't directly wash
the penis; just allow the water to soak the
area.
 Gently pat the area dry with a clean towel.
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 use tepid water without soap.
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 Diapers
 Use two diapers for added protection and cushioning.
 If you notice a dry diaper, call our office
 A spot or two of blood on the diaper is normal.
 Diet:
 Your child can resume a normal diet at home
 Encourage fluids to keep your son's urine clean.
 Activity:
 Restrain and restricted activity first day of operation
 Please encourage quiet play. Watching television, playing board
games or walking.
 Avoid, bicycles and straddling toys.
 Older children should avoid strenuous activities such as
wrestling,‫ المصارعة‬gymnastics ‫ الجمباز‬and bike riding for three weeks.
 There is no need to restrict the activities of infants, except for
swimming and rigorous sandbox play.
Follow-up care
 regular follow-up with your child's pediatric urologist is recommended
after toilet training and at puberty to check for healing and possible
complications
 When the tube is removed, remember to observe the urinary stream. You
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may notice some spraying of urine; this is normal. If you notice a thinning
of your son's stream, call Pediatric Urology.
 If your child is toilet trained, we will need to observe him urinating while
standing up at his next office visit. Encourage him to drink on his way to
the office so that he will be ready to urinate when you arrive.
 A follow-up visit should be scheduled for four weeks after the tube is
removed.
When contact the urologist:
1. Temperature greater than 101° F (38.5)
2. Excessive bleeding (some spotting or blood stains on the dressing is
normal)
3. A lot of urine leakage around the catheter. This means the tube is blocked.
4. The stitches holding the catheter come out.
5. The diaper is dry when it is time to change it.
6. Extreme irritability.
7. Excessive pain
8. Increasing redness of the penis
9. Change in urination
10.Difficulty urinating (pushing when he urinates)
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