Genital Abnormality - Hypospadia: Difference between revisions
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* '''Placental insufficiency in early gestation is associated with hypospadias'''<ref name="PMID18280290"><pubmed>18280290</pubmed></ref> "Of the 104 extremely to very low-birth-weight male infants, 16 (15.3%) had hypospadias, and 10 (62.5%) of those had severe proximal hypospadias. Sixty-two controls who did not have hypospadias and whose body weight was less than 1500 g were identified. The incidence of hypospadias in full-term male birth in the hospital was 12 (0.30%) in 3959 births. Birth body weight and their SD for gestational age were lower in patients with hypospadias compared with those for controls (824 +/- 160 vs 1255 +/- 145 g). Placenta-to-fetal ratio (0.323 +/- 0.07 vs 0.229 +/- 0.03) and gestational age were significantly higher in the patients with hypospadias. Histopathologic study of the maternal placenta obtained from the patients with hypospadias revealed pronounced degenerative changes, infarction, and calcification, whereas these abnormalities were rare in controls. The significant association between the occurrence of hypospadias and early growth retardation with higher placenta-to-fetal ratio and placental abnormalities suggest that placental dysfunction in early gestation may play an important role in the development of hypospadias." | |||
* '''Correction of Distal Penile Hypospadias''' | * '''Correction of Distal Penile Hypospadias''' | ||
** "The major aims of correction of hypospadias include construction of a neourethra, removal of the chordee, and reduction of the probability of postoperative fistulization. Here, we describe a new technique that can be easily used in cases with subcoronal distal penile hypospadias (even those with chordee) for the construction of the urethra using meatus-based transverse flaps."<ref><pubmed>20548222</pubmed></ref> | ** "The major aims of correction of hypospadias include construction of a neourethra, removal of the chordee, and reduction of the probability of postoperative fistulization. Here, we describe a new technique that can be easily used in cases with subcoronal distal penile hypospadias (even those with chordee) for the construction of the urethra using meatus-based transverse flaps."<ref><pubmed>20548222</pubmed></ref> | ||
** "Meatal mobilization (MEMO) by distal urethral preparation has been demonstrated to be an efficient surgical technique for the correction of distal hypospadias offering excellent short-term success rates."<ref><pubmed>20450394</pubmed></ref> | ** "Meatal mobilization (MEMO) by distal urethral preparation has been demonstrated to be an efficient surgical technique for the correction of distal hypospadias offering excellent short-term success rates."<ref><pubmed>20450394</pubmed></ref> | ||
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==Hypospadia Classification== | ==Hypospadia Classification== | ||
[[File:Hypospadia classifications.jpg|thumb|400px|Classification of Hypospadias<ref name="PMID11713004" />]] | [[File:Hypospadia classifications.jpg|thumb|400px|Classification of Hypospadias<ref name="PMID11713004" />]] |
Revision as of 07:40, 17 May 2015
Embryology - 15 Jun 2024 Expand to Translate |
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Introduction
Hypospadias are the most common penis abnormality (1 in 300) and result from a failure of male urogenital folds to fuse in various regions, the normal process is described as virilization of the external genitalia. This in turn leads to resulting in a proximally displaced urethral meatus or opening. The cause is unknown, but suggested to involve many factors either indivdually or in combination including: familial inheritance, low birth weight, assisted reproductive technology, advanced maternal age, paternal subfertility and endocrine-disrupting chemicals.[1] Infants with hypospadias should not undergo circumcision.
Some Recent Findings
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More? References | Discussion Page | Journal Searches | 2019 References | 2020 References Search term: Hypospadia <pubmed limit=5>Hypospadia</pubmed> |
Hypospadia Classification
The condition is classified by the general location of the relocated opening (meatus) and lack of fusion.
Hypospadia Classification | Meatus Opening | Image |
Anterior | on inferior surface of glans penis | A |
Coronal | in balanopenile furrow | B |
Distal | on distal third of shaft | C |
Penoscrotal | at base of shaft in front of scrotum | D |
Scrotal | on scrotum or between the genital swellings | E |
Perineal | behind scrotum or genital swellings | F |
Surgical Repair
Depending on the class of hypospadias there are a number of different surgical repair techniques including: orthoplasty or penile straightening, urethroplasty, meatoplasty and glanuloplasty, scrotoplasty (oscheoplasty) and skin coverage.
Maternal Factors
Data from a case-control study in Sweden and Denmark (2000 - 2005) identified a number of maternal factors that may be associated with hypospadias.[5]
- Maternal diet during pregnancy lacking both fish and meat - more than 4-fold increased risk
- Maternal obesity - more than 2-fold increased risk
- Maternal hypertension - 2.0-fold increased risk
- Maternal absence of nausea - 1.8-fold increased risk
- Maternal nausea in late pregnancy - also appeared to be positively associated with increased risk
Molecular Factors
- chromosomal abnormalities
- HOX, FGF, Shh - genes of penile development
- WT1, SRY - testicular determination
- luteinizing hormone (LH) receptor
- 5alpha reductase, androgen receptor - action of androgen
- CXorf6
- ATF3
Links: OMIM - CXorf6
Related Genetic Conditions
- X-linked isolated hypospadias-1 HYSP1 OMIM 300633
- X-linked isolated hypospadias-2 HYSP2 OMIM 300758
- X-linked isolated hypospadias-3 HYSP3 OMIM 146450
- Johanson-Blizzard syndrome[6] - hypospadias, failure to thrive, exocrine pancreatic deficiency, short stature and developmental delay, cutis aplasia on the scalp, aplasia of alae nasi, hypothyroidism, myxomatous mitral valve, and patent ductus arteriosus.
References
Reviews
Articles
Search Pubmed
June 2010 "Hypospadia" All (4698) Review (377) Free Full Text (413)
Search Pubmed: Hypospadia | Hypospadia Surgical Repair
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Cite this page: Hill, M.A. (2024, June 15) Embryology Genital Abnormality - Hypospadia. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Genital_Abnormality_-_Hypospadia
- © Dr Mark Hill 2024, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G