Proximal hypospadias: current management

Abstract

Hypospadias is an association of three anatomical anomalies of the penis: an abnormal ventral opening of the urethral meatus which can be located anywhere on the ventral aspect of the penis, an abnormal ventral curvature of the penis (chordee) and an abnormal distribution of the foreskin around the glans with the ventrally deficient hooded foreskin. The chordee is a common finding but not a constant one.

Hypospadias appears at the crossroads of genetic and environmental mechanisms. However the occurrence of hypospadias remains unexplained in most cases. A multifactorial explanation and the implication of unknown genes or unidentified environmental factors remain possible.

Hypospadias is the most common congenital anomaly of the penis, affecting 0.4–8.2 of 1000 live male babies (10- 15% of which are proximal hypospadias.

Hypospadias is classified according to the meatal position, as anterior or distal (glanular, coronal, subcoronal), middle (midpenile), or posterior or proximal (posterior penile, penoscrotal, scrotal, perineal). The level of division of the corpus spongiosum may provide a more accurate mean of classification.