Türk Plast Cer Derg (1993) Cilfcl, S ayı: 2
A CASE OF HYPOSPADIAS WITH ANAL LOCALIZATION
Erdem YORMUK, Necmettin KUTLU, Mustafa ÖZBEK
Ankara University Medical Sclıool, Plast i c and Re-constructive S ur «ay Departman. Cebeci, Ankara, Turkey.
SU M M A R Y
A case o f hypospadias with anal localization is reported. This very rare anomaly is discussed in connection with üs place in the classifıcatio n.
Key Words : Anal hypospudias - very rare localization - dassi- ficutioıı.
Hypospadias is oııe of the most cotnınoıı eongenital anomalies of üıe male genitalia characterized by the ureüıral meatus located oıı the veııiral surface of the pe
nis. In different series, the ineideııce of the anomaly has been reported as 1 to 8.2 in 1000 alive male birtlıs, tlıus the average hıcidence has geııerally been aecepted to be
1 in every 300 (1, 2, 3).
On the other hand, tlıe hıcidence of the abııormal lo
calization of tlıe urethral meatus in the haypospadias de- formity is; 40-75 % in Üıe glandular type (B), 12-30 %
in the peııile type (C) and 10-15 % in the nıost severe forms suclı as the peno-serotal, serotal and perineal types (D, E, F). (4), (Figüre 1).
In the light of these statistical perceııtages, a hypo
spadias anomaly case is reported in connection witlı a very rare localization.
CASE REPORT
M.K., a 16-year-old, yomıg male patieııt, was re- ferred to our clinic because of having to urinate by sit- ting and e jaculate Corning from the openiııg at üıe tın al mucoculaneal border on masturbation. He was admitted to our department on the 23.3.1087 with the protocol number 137.
He was hospitalized in 1974 in Üıe State hospital where radiological extuninations were carried out. Ilı e
ÖZET
Anal lokaliz,asyona sahip bir hipospadias olgusu sunulmakta
dır. Çok nüler rastlanabilen bu anomali, sınıflandırmadaki yeri açısından tartışılmaktadır.
Anahtar Kelimeler : Anal hypospadias - Çok ender lokalizas- yoıı - sınıflandırma.
sauıe ye ar, he wâs referred l.o Üıe Department of Urolo- gy, Alıktım University, Faculty .of Mediciııe (15.7.1974 prof no. 454). Here, perineal exploration w as performed (17.7.1974 op. no. 390) and as a result it. was stated that tlıe uretlıi'a was ııot preseııt in the corpus spongiosum but soıne fibrotic remmants eould be observed. The pa- tient was disclıarged witiıout any further reconstructive inlerveııtioıı.
Iıı tlıe faınily lıistory, he stated that his uncle had the hypospadias anomaly.
At Üıe physical examiııation, the urethral meatus . was observed to öpen at Üıe anal mucocutaneal border (Figııre 2). There was no meatal openiııg at the glaııs pe
nis, ııo clıordee deformity and ehcumcisioıı was per
formed at 4 years of age. The testicles were palpable in the serotum and were normal. The other secondary sex characteristics were developed as in the nüde sex. No other anomaly was existiııg.
The laboratory examiııatİons were ali nonnal.
Duriııg Üıe operatioıı peıformed on Üıe 1.5.1987, urelhroplasty was carried out with a modıfied Deııis Bıov/ııe technique, usiııg Üıe skin flaps from the peri- ııeuın, serotum and penis. Thus, the urethral meatus was brought from Üıe anal canal to Üıe tip of Üıe glans (Fig
üre 3). Tlıe post-operalive period was uneveııtful and the patieııt was disclıarged wiÜıout aııy complicatioıı.
139
A CASE OF HYPOSPADIAS
Figüre 1. The i ncidence ofthe ahnormtıl localiz.ation of the urethra! w e at us in the hypospadias deformity; A- Normal Locülizotion, B- Glandular typ (40-75 %), C- Penile type (12-40 ^ 7u), D- T e- nâscrotaltype, E - Ser ot al type (10-15 %). F- Perineal type, G- ANAL HYPOSPADIAS
Fisure 2. Appearencc ofthe urethml mc.au.t apenmg al ıhc Figüre 3. Appcarence of the ü retim i tutamı bmughtfrom the anal mucocıianeal bonkr. “'•“I r m d Ut the hp o} the glam.
Türk Plast Cer Derg (1993) Cilt: 1, Sayı:2
At the post-operative 3 moııths control, normal voiding pat tem was ohserved tmd the patieııt w as in complete physiologie and psyclıologic satisfiıctioıı alter one year (Figüre 4 - a . b).
Figüre 4. a) Appearance o f the case ıvith a good acsthetic and functional ı-e.su.lt at t he postoperaiive 3 moııths control.
b) Normal voiding paltern ohserved at the posîoperative one year control.
DISCUŞSION
In tlıe hypospadias an ona tıly, tlıe localizatioıı ol tlıe urethral meatus not oııly deterıniııes tlıe severi ty ot tlıe deformity, but also is tlıe’ maiıı tactor ıhat dictates its classification.
Actually, t lıere lıave been several classification s suggested but tlıe one that has generally been accepted is a l'ollotvs; 1) Glandar 2) Distal penile 3) Proximal pe- nile 4) Penoscrotal and the 5) Perineal (2, 5, 7, 8, 9).
However, Barcat (6) makes a classification which con- siders the final localizatioıı of the urethral meatus after tlıe associated anomaly (i.e. chordee) has beeıı correct- ed. According to him the classification should be made as follovvs; I) Anterior hypospadias II) Medial hypospa
dias III) Posterior hypospadias IV) Atypical foıms.
With its features stated above, our case is no doubt a hypospadias deformity and because its urethral meatus opens like a double-barrelled-gun at the anal mucocuta- ııeal border, it can be eonsidered within the atypical forms of Barcat’s classification. However, we could not place it in the generally accepted from. Could this case ever add tlıe term "Anal hypospadias" to tlıe nomencla-
lure?..
Prof. Dr. Erdem YORMUK
Ankara University Faculty of Medicine Departmen of Plastic and Reconstructive Surgery
Cebeci-Ankara, Turkey
REEEREN CES
1. Backus, L.H.. DeFelice, C.A.: Hypospadias-Th en anc now. Plast. Reeonstr. Surg. 25:146, 1960.
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3. Farina. R. et al.: Hypospadias. Plast. Reeonstr. Surg. 25 636, 1959.
4. Hagerty. R.F. and Talıer. E.: Hypospadias. Am. Surgeon 24:244, 1958.
5. Çenetoğlu, S.: Baran Yönteminin Glanüler Sulkus Onan mı ile Estetik ve Fonksiyonel Yönden Madifİkasyonı (Uzmanlık Tezi) Ankara, 4, 1986.
6. Barcat, .T.: Current eoncept of treatment. Iıı Hoıton, C.E.
(Ed.) Plastic and Reconstructive Surgery of the Genita Area (İst ed.). Little Brown and Co., Boston. pp,249
1972.
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8. Hortoıı, C.E., Devine, C.J., Adamson, J.E, Carrawa}
I.H.: Hypospadias, Epispadias and Extrophy of the Blad der. In Grablı, W.C., Smith, J.W, (Ed.) Plastic Surgery (3eı*d ed.) Little Brown and Co., Boston. pp,855, 1979.
9. Spence, H.M. et al.: Panel Discussion, Anomalies of Eti ternul Geııitalia in Infancy and Chİldhood. ,T, of Urol. 93:
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