A Standardized Classification of Hypospadias

Objective: Systems for categorizing hypospadias are based on the location of the external meatus. The presented proposal draws on the organogenesis of the urethra and its position against the bone structure of the pelvis. The aim of the study was to examine the position of the corpus spongiosum division relative to pelvic bone structures as an indicator of the true level of hypospadias.

Patients And Methods: The study involved 150 patients aged 6 months to 22.8 years admitted for primary repair. The division of the corpus spongiosum was examined relative to the shaft of the penis and the upper pubis. Hypospadias above the pubis was categorized as penile, while below was proximal, with further subcategorization. The quality of the distal urethral canal was assessed.

Results: The external meatus was above the pubis in 94.1% while the division of corpus spongiosum was located above the pubis in 90% (distal penile 38%, mid shaft 25.3%). There was a considerable difference in hypospadias level relative to the indicator used. The distal meatus/urethra was stenotic in 84%, hypoplastic in 86.8% with true chordee in 10.4%.

Conclusions: A classification of hypospadias based on organogenesis and in respect to bony structures of the pelvis seems reliable, consistent, and more surgically oriented. The distal urethral canal should be regarded as a fistula.