Prevalence: 1 in 125 live births, and it appears to be steadily increasing. It is an anomaly of termination of the urethra that does not open at the top of the glans but at the ventral face of the penis, at some distance from the glans (see picture). Its etiology is unknown, but it appears that environmental factors with anti-androgenic activity play a decisive role by interfering with the expression of genes involved in the secretion of testosterone.

Clinically, hypospadias results in an abnormality of the orientation of the urinary jet and the morphology of the distal end of the penis: the foreskin is not fused in its posterior part, revealing the posterior face of the glans and the ectopic position  of the urethral orifice. There may also be a bending of the shaft ("chordee").

The goal of surgery is to create a new urethra, surrounded by quality spongy tissue and opening at the end of the gland, and to remove the chordee when it exists (about 50 % of cases). Different types of surgical techniques are used, depending on the severity of the hypospadias but also according to personal preferences of the surgeon.

Anesthetic implications:

renal echography (to exclude associated abnormalities); an ultrasound exalination of the lumbosacral spine may be useful as it appears that hypospadias is associated with a higher prevalence of spinal abnormalities (tethered spinal cord ?); general anesthesia associated with a pudendal, caudal or penile block, sometimes lumbar epidural analgesia. The association between a caudal block and an increased risk of post-operative complications (fistula) was a matter of controversy., which has been cleared: the caudal block does not increase the risk of surgical complications.

References :

-        Koo B-N, Hong J-Y, Song H-T, Kim JM, Kil HK.
Ultrasonography reveals a high prevalence of lower spinal dysraphism in children with urogenital anomalies.
Acta Anaesthesiol Scand 2012 ; 56 :626-8.

-        Naja ZM, Ziade FM, Kamel R, El-Kayali S, Daoud N, El-Rajab MA.
The effectiveness of pudendal nerve block versus caudal block anesthesia for hypospadias in children.
Anesth Analg 2013; 117: 140-7.

-        Ayob F, Arnold R.
Do caudal blocks cause complications following hypospadias surgery in children ? (editorial).
Anaesthesia 2016; 71: 773-8.

-        Graga LH, Jegatheeswaran K, McGrath M, Easterbrook B et al.
Cause and effect versus confounding: is there a true association between caudal blocks and tubularized plate repair complications?
J Urol 2017; 197: 845-51

-        Splinter WM, Kim J, Kim AM, Harrison M-A.
Effect of anesthesia for hypospadias repair on perioperative complications.
Pediatr Anesth 2019; 29: 760-7 

-        Fischer KM, Van Batavia J, Hyacinthe N, Weiss DA, Tan C, Zderic SA, Mittal S, Shukla AR, Kolon TF, Srinivasan AK, Canning DA, Zaontz MR, Long CJ. 
Caudal anesthesia is not associated with post-operative complications following distal hypospadias repair.
J Pediatr Urol. 2023; 19 :374-9

-        Adler AC, Austin PF. 
Caudal block for hypospadias repair: Unfolding the controversy through statistical analysis and how we can put it all to rest! 
Pediatr Anesth. 2024; 34: 108-11.

       

Updated: January 2024