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Hypospadias
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
The degree of ventral curvature influences the type of hypospadias repair. Even if the urethral opening is not severely ectopic, the penis may require an extensive reconstruction (even a staged one) in order to accomplish adequate straightening of the phallus. Preoperatively, gentle retraction of the penile base allows a reasonable assessment of the location and the severity of overall chordee.
Urology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
While for the most minor degree of hypospadias no surgery or only excision of the hooded prepuce can be considered, the remainder are likely to require operative correction. The first step of surgery is the correction of the chordee, followed by urethroplasty and skin cover. Depending on the abnormality, the surgeon will advise either a single-stage or two-stage procedure using the prepuce as a graft for the urethroplasty. Therefore, parents must be counselled against circumcision of a newborn baby boy with hypospadias.
Genitourinary and trunk
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Hypospadias results from incomplete closure of the urethral folds during the 12th week of development and may represent abnormal fusion between endodermal and ectodermal processes. It occurs in 1 in every 300 live male births and seems to be increasing; it is characterised by Ventral meatal dystopia, i.e. ventral position of the meatusDorsal hooded foreskinVentral curvature on erection (chordee) This is a fibrous remnant of the corpus spongiosum causing ventral penile curvature that may occur without hypospadias. Dissection of the urethral plate alone will not correct the curvature. In >90% of cases, chordee is due simply to ventral skin shortage; the aetiology is uncertain.Artificial erection test. See below.Deficiency of ventral skinClefting of the glans, and in the most severe cases scrotal bipartition
New frontiers on the molecular underpinnings of hypospadias according to severity
Published in Arab Journal of Urology, 2020
Coriness Piñeyro-Ruiz, Horacio Serrano, Marcos R. Pérez-Brayfield, Juan Carlos Jorge
Classification of hypospadias severity follows the anatomical location of the urethral meatus. Clinton K. Smith [12] was the first to classify hypospadias according to the location of the urethral meatus. He classified hypospadias as first degree (opening is situated in the distal one-third of the penis); second degree (proximal two-thirds of the penis to the penoscrotal junction); and third degree (point backward to the perineum). Thereafter, Schaefer and Erbes [5] employed Smith’s degrees as glandular (first degree), penile (second degree), and perineal (third degree). Although these classification systems based on anatomy are useful, clinicians noted that surgical correction of ventral foreskin tethering and/or significant chordee might displace the urethral meatus to a different location, which may lead to misclassification of severity. Therefore, the Sheldon and Duckett [6] classification system, modified after Barcat’s classification, considers the meatus position after chordee has been released. They classified hypospadias as anterior hypospadias, described as glandular (located near the tip of the glans), subcoronal (located just below the coronal sulcus; middle hypospadias (distal penile and midshaft); and posterior hypospadias (proximal penile and penoscrotal meatus), scrotal (located in the scrotum), and perineal (located below the scrotum and perineum). Hypospadias can also be grouped as mild (Type I), moderate (Type II), and severe (Type III) hypospadias, which can be grouped further as mild (Type I) and severe (Type II and III) hypospadias. About 70% of cases are mild, and the remaining 30% are severe [8–10,13,14]. Given the tremendous advances in molecular biology techniques over the last few decades, the present review aimed to highlight the emerging scenarios with regard to key biological factors that have been related to hypospadias according to the severity of the condition.
Non-transecting urethroplasty in patients with bulbar urethral strictures shorter than three centimeters
Published in Scandinavian Journal of Urology, 2023
Muhammet Şahin Yılmaz, Alihan Kokurcan, Fahrettin Şamil Uysal, Görkem Özenç, Fatih Yalçınkaya
Three of 22 (13.6%) patients in the EPA group had complications. While one patient developed erectile dysfunction, one experienced a scrotal hematoma and one developed chordee. The patient with erectile dysfunction was treated with oral tadalafil treatment. Conservative treatment was given for the scrotal hematoma. These patients responded well to these treatments. The chordee was not treated since it was not associated with erectile dysfunction or an inability to have sexual intercourse.
Quantification of the Androgen and Estrogen Receptors in the Penile Tissues of Hypospadias in Comparison with Normal Children
Published in Fetal and Pediatric Pathology, 2023
Sanat Khanna, V. Shankar Raman, Sonia Badwal, K. V. Vinu Balraam
Of the 75 boys in the Group A, majority had DPH (39/75; 52%), 23 cases (30.7%) had MPH (moderate variety) while the remaining 13 cases (17.3%) had PPH or PSH (severe variety). Among these 75 cases, 35 cases (46.7%) had associated chordee with skin chordee accounting for 20, the other 15 were severe.