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The first 25 slides, exactly as they appear. The full deck has 82 content slides.
Paediatric Surgery
Hypospadias
Built from Puri — Pediatric Surgery and Pediatric Urology
What’s inside
11 sections · 82 slides
Overview
- How to read this deck
What Hypospadias Actually Is
The anatomy of the defect
- The core idea in plain language
- The signature “triangle” of deficient tissue
- The ventral triangular defect of the hypospadiac penis
- Two different results of an early stop
- The three classic clinical features
How Common Is It?
Incidence, ethnicity and the debate over rising rates
- Hypospadias by the numbers
- Who gets it — family and ethnicity
- Is hypospadias becoming more common?
How the Penis Is Normally Built
Embryology of the genital tubercle
- Where the genital tubercle comes from
- How the urethra tubes itself
- Timeline of genital-tubercle development
- The hormone engine: testosterone and DHT
- The masculinization programming window (MPW)
- Supporting cast: growth hormone and AMH
The Four Players Behind It
Fetus, placenta, mother, environment
- Four protagonists of genital construction
- Player 1: the fetus
- Players 2 & 3: placenta and mother
- Player 4: the environment
- A hormonal echo after birth: “minipuberty”
- From childhood quiet to puberty
Biological Errors That Cause It
Chromosomes, genes, hormones and tissues
- Chromosomal anomalies
- Genetic anomalies — a familial signal
- Candidate gene groups in hypospadias
- Faulty hormone factories: the dysgenetic gonad
- When the tissues can’t hear the hormone
- Placental insufficiency and the twin clue
- The mother’s health and exposures
Reading Anatomy & Sorting Severity
Classification that guides surgery
- From tip to base: what the surgeon sees
- Associated anomalies to look for
- Why classify by the spongiosum, not the meatus
- Distal division of the corpus spongiosum
- Proximal division of the corpus spongiosum
- A hypospadias “cripple” after failed repairs
- The three severity categories
Getting Ready for Surgery
Hormonal priming and endocrine screening
- Preoperative androgen stimulation — why do it
- Koff’s downgrading concept
- Three ways to give the hormone
- The downside: androgens and healing
- Timing is everything
- Endocrine and genetic screening
The Surgical Toolkit
Three steps and a family of urethroplasties
- Three steps behind almost every technique
- Step 1: degloving and straightening
- Correcting curvature by dorsal plication (TAP)
- Step 2: choosing the urethroplasty
- Tubularizing a healthy urethral plate (Thiersch-Duplay)
- Incising then tubularizing the plate (Snodgrass/TIP)
- Preputial patch onto the plate (onlay)
- Perimeatal flip-flap repair (Mathieu procedure)
- Mobilizing the native urethra (Koff technique)
- Building a new tube (Asopa-Duckett)
- One-stage repair of severe cases (Koyanagi)
- Two-stage free-graft repair (Cloutier-Bracka)
- Step 3: rebuilding the underside
- Around the operation: practicalities
What Can Go Wrong Afterwards
Evaluation and complications
- Why judging the result is hard
- Functional evaluation of the new urethra
- The main families of complication
- Fistulae: leaks in the repair
- Stenosis, ballooning and late curvature
- The utricle, ejaculation and psychology
- Complications tied to specific techniques
- Factors that drive the complication rate
Key Messages
Conclusion, takeaways and references
- Conclusion and future directions
- Three ideas to remember
- Why is the level at which the corpus spongiosum divides a better severity marker than the position of the urethral meatus?
- References (1/4)
- References (2/4)
- References (3/4)
- References (4/4)
- Pediatric Surgery and Pediatric Urology