Case report

Hypospadias
Budi Haryadi
1808436757
PEDIATRIC SURGERY
ARIFIN ACHMAD GENERAL HOSPITAL RIAU PROVINCE
Patient’s Identity

Name : An. NF City : Bengkalis

Age : 12 years Religion : Islam
Date Birth : 13-11-2006 Tribe : Melayu
Sex : Male Arrived on hospital : 19-02-2019
Occupation : Student MR : 01008755
Study : Junior High School
Address : Sudirman street, Sungai Pakning dumai
ANAMNESIS

Chief complaint:
Urinary hole is located under the penis

Present Illness History:

Since born, patient’s mother complained of her’s child ureter that located under penis. the
urine doesn't flow properly. But the patient's mother does not take the patient to the doctor
and still leave it. The pee patient doesn’t flow properly, no pain, the pee frequency 4 until 6
times a day, the pee color is clear yellow, no blood, no pus and no history of fever.

Past Illness History:

There are no complaines related to complains at this time
ANAMNESIS

Family illness history:

His brother (6 years) have the same complaint
Mothers of patients have a history of ulcer and asthma since high school (+)

Pregnancy, Birth and immunization history:

Pregnancy: 12 week gestational age patient had history of ulcer (+), the mother taking
medication (+), hipertensi (-), ANC : regulary, USG (-)
Birth: The patient of the first child of 5 siblings, the patient was born spontaneous and helped
by midwife
Immunization: Complete immunization
 GENOGRAM

An. NF
12 yo

father patients with hypospadias

mother Brothers
 PHYSICAL EXAMINATION

STATUS GENERALIS
General appereance : Good
Consciousness : Composmentis cooperative

Vital Sign
Blood Pressure : 120/70 mmHg Head & Neck : Normal
HR : 88 x/minute Thorax : Normal
T : 36,5˚C Abdomen : Normal
RR : 20 x/minute Ekstremity : Normal
VAS : no pain Lymph nodes : Normal
GCS : 15 Genito urinarius : Localized state
Body weight : 32 kg Neurological status : Normal
Body Height : 139 cm
 UROLOGICAL EXAMINATION

Flank Area

Examination Dextra Sinistra

Inspection Inflamation (-) (-)
Skar (-)
Ballotement (-) (-)
Tenderness (-) (-)
Pain hit (CVA) (-) (-)

Suprapubis
Inspection : symetric, flat, signs inflamation (-), distensi (-)
palpation : massa (-), tenderness (-)
 GENITALIA EKSTERNA

Penis
Inspection : OUE is located in the glandular, hoodlike
appearance (+) , sirkumsisi (-), signs of trauma (-), blood (-), pus
(-).
Palpation : size 5 cm, massa (-), pain (-)

Skrotum
Inspection : signs of trauma (-), signs of Inflamation (-).
Palpation : testis (+/+), size normal, Tenderness (-), massa(-)
WORKING DIAGNOSE:
Glandular Hypospadias

WORK UP PLAN:
Blood routine test
Rontgen thorax
WORK UP RESULT:
Lab.
• Hb : 13,9 g/dl PT : 13.8 s
• Ht : 39,1 % APTT : 37.3 s
• Eritrosit : 4.89 10^6 /uL INR : 1.03
• Leukosit : 6.55 10^3/uL
• Trombosit : 250 10^3 /uL

X-foto thorax:
Cor : normal size and shape
Pulmo : normal broncovaskular marking, infiltrat (-) (there is no abnormality)
normal diaphragm and costophrenic angles
DIAGNOSIS: Glandular Hypospadias

DIFFERENTIAL DIAGNOSIS: Ambiguous Genitalia

Anomaly Genitalia

TREATMENT:

Operative : Post - operative:

Chordectomy Cefotaxime 2 x 1 g
Urethroplasty Paracetamol 3 x 350 mg
March,20th 2019
Hypospadias
 DEFINITION

HYPOSPADIAS
Comes from Greek, Hypo (under, below) and spadon (gap, crack, fissure).
Congenital anomaly in the boys genitalia externa where the externa meatus
urethra is located in ventral penis.

3 anomaly of penis
1) meatus urethra located in the ventral of penis
2) Deviation of ventral penis (korda)
3) prepuce hood dorsal that associated with ventral preputium deficit
 EPIDEMIOLOGY

HYPOSPADIAS

 Around 80% cases of hypospadias is classified as isolated

hypospadias, which means hypospadias without any other
associated congenital anomalies
 1:300 births
 Paternal family history of hypospadias (8%) or brothers (14%)
 EMBRYOLOGY

Sertoli cells leydig cells

CLASSIFICATION
 ETIOLOGY

• Hormonal imbalance and disturbance

• Genetics
• Environmental
 DIAGNOSIS
Anamnesis:
• Urine doesn’t come out from the upper side of penis
• Difficulties in aiming
• Crooked penis to ventral
• Risk Factors:
• Paternal family history (8%) or brothers (14%)
• Hormonal treatment in pregnancy
Physical Examination:
• Abnormal curvature of penis
• Length of dorsal preputium is longer than ventral (Hoodlike appearance)
• Meatus urethra is located in more proximal site, often looks stenotic
• Testis examination (undencended testis +/-)
• Penis length examintaion (micropenis)

Lab and other tests:

karyotyping and urinary tract USG and other genital interna organs is indicated if genital ambiguity
were found:
– Hypospadia with the absence of both testis
– Hypospadia with micropenis and absence of one or both testis
 TREATMENT
Operative:

Chordectomy, cut connective tissue so the penis can be straight

Urethroplasty, reconstruction urethra to distal

 COMPLICATION

– Psychic (shy)
– Infertility
– Risk of hernia inguinalis
– Psychosocial disorder
– Not anatomical penis
– Twist to lateral
– Infection
Post-operative
– Orocutaneous fistulas
– Edema
– Stricture
– Hair in the urethra
– Chordee diverticulum recureence
Thankyou