Early Diagnosis, Repair and Common Post Operative Complications of Hypospadias

摘要

Hypospadias is an abnormality of anterior urethral and penile development in which the urethral opening is ectopically located on the ventrum of the penis proximal to the tip of the glans penis, which, in this condition, is splayed open. The urethral opening may be located as far down as in the scrotum or perineum. The penis is more likely to have associated ventral shortening and curvature, called chordee, with more proximal urethral defects. During the early millennium, the primary treatment for hypospadias was amputation of the penis distal to the meatus. Since that time, many have contributed to development of modern hypospadias repair. Over couple of hundred different types of repairs have been described in the medical literature. Although most reports have been in the last half century, most basic techniques were described over a century ago.With up to date technological application in prenatal medicine, hypospadias can be detected on prenatal ultrasound examination. The prenatal diagnosis may not be made for every isolated fetal anatomical malformation; however, a skilled ultrasound examiner and a family history can optimize prenatal ultrasound diagnosis carried out in third trimester. Modern anesthetic techniques, fine instrumentation, sutures, dressing materials, and antibiotics have improved clinical outcomes and have, in most cases, allowed surgical treatment with a single-stage repair within the first year of life on an outpatient basis. It is clear that repairs that are more proximal are associated with a greater incidence of complications. Older age at surgery and low surgical experience have also been associated with poorer outcomes. With longer follow-up, it is apparent that late complications can occur and most advocate continued evaluation through puberty.In conclusion, among postoperative complication, bleeding rarely occurs and is usually controlled with a compressive dressing. Infrequently, this requires reexploration to evacuate a hematoma and to identify and treat the source of bleeding. Local edema and blood spotting can be expected early after repair and generally do not cause a significant problem. Urethrocutaneous fistulization is a major concern in hypospadias repair. Infection is a rare complication of hypospadias repair in the modern era. Skin preparation and perioperative antibiotics are generally used.