Hypospadias Classification and Repair: The Riddle of the Sphinx

Abstract

Hypospadias is the most common congenital anomaly of the penis, affecting 0.4–8.2 of 1000 live male babies [1]. The term hypospadias stems from twoGreekwords: hypo,which means ‘‘below,’’ and spadon, which means ‘‘hole.’’ The anomaly is characterized by a urethral meatus ectopically located proximal to the normal place on the ventral side of the penis. Different anatomic presentations can be observed. The position of the urethral meatus can be classified as anterior or distal (glandular, coronal, or subcoronal; 60–65% of cases), middle (midpenile; 20–30% of cases), or posterior or proximal (posterior penile, penoscrotal, scrotal, or perineal; 10–15% of cases) [2]. The subcoronal position is themost common. Proximal cases are considered severe and can be associated with chordee [2]. The term chordee derives from the Greek word chorda, which means ‘‘string’’ or ‘‘rope’’ and indicates the ventral curvature of the penis. Clinical symptoms vary and depend on the severity of the disease. In mild hypospadias with a urethral meatus located on the glans, a normal urinary flow can be maintained. In cases with a stenotic meatus, a weak urinary flow can be observed. Children with proximal hypospadias with penile curvature might not be able to void while standing. Actually, we do not know precisely what degree of penile curvature in children will inhibit sexual intercourse in adulthood or what the long-term psychosexual outcome will be in these patients. Many questions still arise on several aspects of the disorder, such as how to objectively define the severity of the disease, what is the real benefit of preoperative hormonal stimulation, and particularly, what is the best surgical correction to adopt according to type and severity of hypospadias [3]. Generally speaking, the assessment of severity is based on meatal position, quality of the urethra and urethral plate, and presence or absence of penile