CHAPTER 94 Hypospadias

Introduction Hypospadias is a wide spectrum of abnormalities involving the inferior surface of the penis and having in common a urethral opening that lies on the inferior surface of the penis, (hypo = under; spadias = opening or rent). The spectrum of hypospadias anomalies includes an abnormal urethral opening, chordee (ventral curvature of the penis), an incomplete prepuce, rotation of the penis, abnormal raphe, and disorganised corpus spongiosum and penile fascia. Worldwide, hypospadias surgery is known to be challenging and technically demanding. In some parts of Africa, this is complicated by unawareness and some deleterious cultural and religious beliefs. Hence, the majority of hypospadias patients in Africa are referred late, already circumcised or with signs of mutilation due to failed repair or cultural practices. In addition, suboptimal theatre conditions, lack of delicate instruments and suture materials, and high infection rates in some parts of Africa make hypospadias repair even more difficult.