Hypospadias - optimum methods of treatment

Czech version

Authors: I. Novák
Authors‘ workplace: Urologická klinika LF UK a FN Hradec Králové
Published in: Urol List 2007; 5(1): 37-41

Overview

Hypospadias, the urethra cleft on lower parties, is the most frequent congenital anomaly of the urinary tract. Prevalence is from 5.2 to 8.2 cases in 1000 born boys.

Classificacion of hypospadias has been based on the meatal position - distal shaft 50% (glandular, coronal, subcoronal), mid shaft- 20% (penile) and proximal shaft - 30% (penoscrotal, scrotal, perineal). The hypospadias with chord occurs as an isolated unit. Defect should be diagnosed immediately after birth up to 3-6 months by a paediatrist and then considered by a peadiatric urologist.

The treatment is only surgical. Recent trend has been to operate on hypospadic boys in the period of 6 month to 2 years of age. Double-layer tubularised incised plate (TIP) urethroplasty has been recently recommended for distal shaft hypospadia. A tubularised flap or a free graft are recommended for modelling the missing part of the urethra in case of mid and proximal shaft hypospadia, using the onlay technique. The “inlay-onlay” urethroplasty according to Kočvara is an option in case of low quality or missing urethral plate. Both cosmetic and functional outcome is important in assessing the effect of urethroplasty. Success rate may only be assessed on the basis of a long term monitoring of post-operative patients.

Key words:
hypospadias, chord, urethroplasty, flap, graft

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