1. Hypospadias, Hydrocele, Cryptorchidism
Ricci pp ; 1585

2. Hypospadias
Urethral meatus underneath the glans or penis rather than midline.
Problems with directing urinary stream, deposition of sperm, and self-esteem.
Requires surgical reconstruction using foreskin.
Children with hypospadias should not be circumcised.

3. Manifestations Meatus not midline Unusual urinary stream
Look for chordee which causes pulling of shaft
May have other conditions such as inguinal hernia, cryptorchidism, or hydrocele

4. Hypospadias

5. Chordee

6. Surgical Management
The surgeon will use a small piece of foreskin or tissue from another site to create a tube that increases the length of the urethra. Extending the length of the urethra will allow it to open at the tip of the penis.

7. Surgical Management
During surgery, the surgeon may place a catheter in the urethra to make it hold its new shape. The catheter may be sewn or fastened to the head of penis to keep it in place. It will be removed weeks after surgery.

8. Hypospadias Repair

9. Postop Management Postop urinary stent or drainage tube
TACCO drainage from tube and check patency
Make sure penis is in upright position to avoid stress on urethral incision
Check pressure dressing on penis
Double diapering to allow for separation of urine and stool (p. 1563) and decrease chance of infection
Antibiotics, antispasmodics, pain meds

10. Parental Education Catheter care
Teach how to irrigate if mucus plug occurs
S/S of infection
No tub baths
Quiet play
No straddling activities

11. Hydrocele Fluid in scrotal sac Sac looks larger Sac is translucent
Usually resolves spontaneously

12. Hydrocele

13. Hydrocele

14. Pathophysiology
A hydrocele can develop in the womb. Normally, the testicles descend from the abdominal cavity into the scrotum. A sac (processus vaginalis) accompanies each testicle, allowing fluid to surround the testicles.

15. Pathophysiology
In most cases, each sac closes and the fluid is absorbed. However, if the fluid remains after the sac closes, the condition is known as a noncommunicating hydrocele. Because the sac is closed, fluid can't flow back into the abdomen. Usually the fluid gets absorbed within a year.

16. Pathophysiology
In some cases, however, the sac remains open. With this condition, known as communicating hydrocele, the sac can change size or, if the scrotal sac is compressed, fluid can flow back into the abdomen.

17. Surgical Repair
If fluid does not reabsorb, surgery may be necessary.

18. Cryptorchidism
Either one or both testicles have not descended during the 7th month of gestation.
May be mechanical, hormonal, chromosomal, or enzymatic.
If left untreated, can lead to sterility and testicular cancer.

19. Risk Factors and Manifestations
Prematurity
First-born child
Cesarean birth
LBW
Hypospadias
Exam reveals either one or no testicles in scrotal sac

20. Cryptorchidism

21. Locations of Undescended Testicles

22. Surgical Management An orchiopexy is the term for surgical correction
An incision is made into the abdomen, the site of the undescended testicle, and another is made in the scrotum (A).
The testis is detached from surrounding tissues (B) and pulled out of the abdominal incision attached to the spermatic cord (C).
The testis is then pulled down into the scrotum (D) and stitched into place (E).

23. Orchiopexy