Hypospadias – Historical Aspects · Hypospadias – Historical Aspects A R MundyA.R.Mundy & D E AndrichD.E.Andrich Institute of Urology London

Hypospadias – Historical AspectsAspects

A R Mundy & D E AndrichA.R.Mundy & D.E.AndrichInstitute of Urology

London

What Is Hypospadias?What Is Hypospadias?

Not In AsiaNot In Asia

(Thiersch) Duplay(Thiersch) Duplay

Excellent Results Hendren (1980)Excellent Results – Hendren (1980)

Meatal SiteMeatal Site

Changing AttitudesChanging Attitudes

WasWas• No real attention to the glans and meatus

NowNow• Mainly attention to the glans and meatus

MAGPIMAGPI

MAGPIMAGPI

‘S d ’ i l ill i‘Snodgrass’ - optical illusion

Unnecessary TraumaUnnecessary Trauma

Post Operative GeneralPost-Operative - General

Glans CleftGlans Cleft

Short UrethraShort Urethra

Deficient DartosDeficient Dartos

????

The UrethraThe Urethra

What Makes It Difficult? 1What Makes It Difficult? - 1

• Small glans• Traumatic soft tissue lossTraumatic soft tissue loss• No dartos• No spongiosum• Previous graft or flap requiring excision• Previous graft or flap requiring excision• Significant chordee• Stricture in previous urethroplasty >3cm• Associated lichen sclerosus• Associated lichen sclerosus

What Makes It Difficult? 2What Makes It Difficult? - 2

• Small penis• Large fistula or multiple fistulaeLarge fistula or multiple fistulae• Scarred penile shaft• Associated bulbar stricture• Associated peno-scrotal transposition• Associated peno-scrotal transposition• Associated obesity

ProblemsProblems

• How to test the listHow to test the list• How to quantify e.g. ‘small’, ‘deficient’• How to score severity:

– Groups of problems = Grade 1,2 or 3p p ,– Score each problem 1,2 3 etc to give a total