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Hypospadias for Medical Personal
Hypospadias - Classification

  • Classification of hypospadias

    • The hypospadias is classified as per site of urethral opening. However, exact type is dependent upon surgical findings, as many a time, an anterior hypospadias  becomes distal penile hypospadias after degloving.

  • By the location of the urethral meatus, hypospadias is classified as

    • Anterior hypospadias

    • Middle hypospadias

    • Posterior hypospadias

  • Anterior Hypospadias

    • Glanular : meatus on the ventral surface of glans penis.

    • Coronal : meatus in the balanopenile furrow.

    • Distal penile: in the distal third of penile urethra.

  • Middle Hypospadias

    • These are the hypospadias along the middle third of the penile shaft.

  • Posterior Hypospadias

    • Posterior hypospadias extends through the proximal third of penile shaft to the perineum. Such as

      • Posterior penile: at the base of the shaft

      • Penoscrotal: at the base of shaft in front of the scrotum.

      • Scrotal: on the scrotum or between the genital swellings.

      • Perineal: behind the scrotum or behind the genital swellings.

  • Differential Diagnosis

    • It is important to eliminate underlying disorder of sex development (DSD) if associated with unilateral or bilateral undescended testis. Congenital Adrenal Hyperplasia is a diagnosis that must not be missed and should be considered in females with ambiguous genitalia. If not detected early this can lead to a salt wasting crisis due to cortisol and aldosterone deficiency with androgen excess.

  • Investigations

    • If not concerned about DSD, no other investigation is routinely required.

    • If there are concerns about DSD, investigations that may be considered are:

      • Detailed history and examination

      • Karyotype

      • Pelvic ultrasound scan

      • Urea and Electrolytes

      • Endocrine hormones: Testosterone, 17 alpha-hyroxyprogesterone, LH, FSH, ACTH, renin, aldosterone

  • Associated Anomalies

    • Undescended testes 9.2%

    • Inguinal hernia 9%

    • Utricle in 11%

    • Renal anomalies 1%

    • Wilms tumour, renal agenesis

    • Pelvic kidney, horse show kidney etc.

    • Severe reflux.

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