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Hypospadias & Epispadias
PptxGenJS Presentation
Prof. Zahid Mahmood
Prof. Zahid Mahmood
1
2026-07-12T04:02:13Z
2026-07-12T04:02:13Z
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بِسْمِ اللَّهِ الرَّحْمَٰنِ الرَّحِيمِIn the name of Allah, the Most Gracious, the Most MercifulPK
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Hypospadias & EpispadiasCongenital Anomalies of the UrethraProf. Zahid MahmoodMBBS, FCPS — General & Laparoscopic SurgeonPK
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Did You Know?In hypospadias the opening is underneath.In epispadias the opening is on top.Hypospadias affects about one in 300 boys.Never circumcise these babies at birth.The foreskin is needed to repair them.PK
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Learning OutcomesDefine hypospadias and epispadias.Describe the classic triad of hypospadias.Contrast the two anomalies clearly.Explain why circumcision is forbidden.Outline the timing and aims of surgery.PK
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Hypospadias — DefinitionA common congenital penile anomaly.The urethral opening is on the underside.It lies short of the normal tip.Due to incomplete fusion of urethral folds.Seen in about one in 300 boys.PK
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Hypospadias — The Classic TriadVentral ectopic urethral opening.Ventral curvature of the penis (chordee).Hooded, deficient foreskin underneath.Excess foreskin on the dorsal side.These three features occur together.PK
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Hypospadias — TypesNamed by the position of the opening.Glanular and coronal — near the tip.Distal and midshaft — along the shaft.Penoscrotal and perineal — more severe.Most cases are distal and mild.PK
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Hypospadias — Associated ProblemsUndescended testis may coexist.Inguinal hernia may be present.Severe cases may need a karyotype.This checks for a sex development disorder.Examine the testes in every case.PK
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Hypospadias — Clinical FeaturesThe urinary stream sprays or points down.The boy may need to sit to void.Chordee bends the erect penis.This can affect later sexual function.There are cosmetic and psychological concerns.PK
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Hypospadias — Management PrinciplesNever circumcise the baby.The foreskin is needed for repair.Repair between six and eighteen months.Complete surgery before school age.Refer early to a paediatric surgeon.PK
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Hypospadias — Surgical RepairStraighten the penis — correct the chordee.Rebuild the urethra to reach the tip.Shape the glans and new opening.Snodgrass repair suits distal cases.Severe cases need a staged repair.PK
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Hypospadias — Complications of RepairUrethrocutaneous fistula is the commonest.Narrowing of the new opening (stenosis).Urethral stricture may develop.Wound breakdown can occur.Some boys need a second operation.PK
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Epispadias — DefinitionA rare congenital penile anomaly.The urethral opening is on the upper surface.This is the dorsal side of the penis.It is part of the exstrophy complex.Much less common than hypospadias.PK
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Epispadias — Types & FeaturesGlanular, penile and penopubic types.The penis curves upward (dorsal chordee).The pubic bones are widely separated.Complete epispadias often causes incontinence.The bladder neck may be deficient.PK
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Epispadias — ManagementTreatment is surgical reconstruction.Rebuild the urethra on the dorsum.Correct the upward curvature.Repair the bladder neck for continence.Surgery is complex and often staged.PK
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Hypospadias vs EpispadiasHypospadias — opening underneath (ventral).Epispadias — opening on top (dorsal).Hypospadias bends the penis downward.Epispadias bends it upward, may leak urine.Hypospadias is common; epispadias is rare.PK
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The Golden RuleNever circumcise a baby with these.The foreskin is precious tissue.It is used to rebuild the urethra.Circumcision wastes it and harms repair.Refer first, operate later.PK
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Take-Home MessageHypospadias — ventral opening, chordee, hooded foreskin.Epispadias — dorsal opening, often with incontinence.Never circumcise; save the foreskin for repair.Repair between six and eighteen months.Always examine the testes as well.PK
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AssessmentTen Single-Best-Answer QuestionsPK
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MCQ 1A newborn boy has the urethral opening on the ventral shaft, downward curvature, and a hooded foreskin. The diagnosis is:A. EpispadiasB. HypospadiasC. PhimosisD. MicropenisE. Isolated chordeeKey: BPK
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MCQ 2A boy with distal hypospadias is brought to the clinic for routine circumcision. The correct advice to the parents is:A. Proceed with circumcisionB. Do not circumcise — foreskin needed for repairC. Circumcise the dorsal skin onlyD. Delay circumcision by one yearE. Circumcise at pubertyKey: BPK
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MCQ 3Two weeks after hypospadias repair, urine leaks from a small opening on the shaft. The most likely complication is:A. Meatal stenosisB. Urethrocutaneous fistulaC. Urethral strictureD. DiverticulumE. Wound infectionKey: BPK
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MCQ 4Parents of a 6-month-old with distal hypospadias ask about timing. The ideal age for surgical repair is:A. At birthB. 6–18 monthsC. At 5 yearsD. At pubertyE. In adulthoodKey: BPK
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MCQ 5A baby has the urethral opening on the dorsal (upper) surface of the penis with upward curvature. The diagnosis is:A. HypospadiasB. EpispadiasC. Isolated chordeeD. PhimosisE. ParaphimosisKey: BPK
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MCQ 6A child with complete penopubic epispadias leaks urine continuously. This incontinence is due to a:A. Urethral strictureB. Deficient bladder neck sphincterC. Meatal stenosisD. Bladder stoneE. Urinary infectionKey: BPK
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MCQ 7A neonate has severe penoscrotal hypospadias with bilateral impalpable testes. The most important next step is:A. Immediate repairB. CircumcisionC. Karyotype to exclude a sex development disorderD. Discharge and reviewE. Start testosteroneKey: CPK
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MCQ 8A boy has distal penile hypospadias with a healthy urethral plate. A commonly used single-stage repair is the:A. Fowler–Stephens procedureB. Snodgrass (tubularised incised plate) repairC. OrchidopexyD. CircumcisionE. Bladder neck reconstructionKey: BPK
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MCQ 9The underlying developmental defect in hypospadias is failure of fusion of the:A. Genital tubercleB. Urethral (urogenital) foldsC. Labioscrotal swellingsD. Mesonephric ductsE. Paramesonephric ductsKey: BPK
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MCQ 10In a boy with hypospadias, the penis characteristically curves:A. Upward (dorsal)B. Downward (ventral)C. To the leftD. To the rightE. It does not curveKey: BPK
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Thank You“A wise surgeon protects what nature gave —never remove what you may need to rebuild.In every child, plan before you cut,and let patience guide your hands.”Prof. Zahid MahmoodPK
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7/23/19Click to edit Master text stylesSecond levelThird levelFourth levelFifth level‹#›PK
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