Summary
Hypospadias is considered to be the result of inadequate fusion of urethral folds
and, possibly, of canalization of a glandar epithelial cord during the formation of
the spongy urethra. This theory had to be reconsidered because a recent study in normal
human embryos has exposed such fusion and invagination as misconceptions. Autopsy
specimens of five penises with hypospadias from foetuses and neonates were studied
histologically. The findings complemented with data from the literature were correlated
to the normal developmental process to reconstruct the pathogenesis of the disorder.
Histopathological analysis revealed that the hypospadic orifice was the proximal part
of a mucosal delta which revealed the structure of the roof and meatus of a flattened
distal urethra. Branches of the raphe bordering the delta and terminating in prominent
‘dog ears’ had the characteristics of the transient urethral labia (folds). Associated
curvature and torsion could be related to structural abnormalities of vascular structures,
notably the distal corpus spongiosum, and fasciae predominantly proximal to the hypospadic
orifice. Correlation with normal development indicated that hypospadias and associated
anomalies are not caused by disturbed fusion or glandar invagination but by maldevelopment
of a complex of primordial fascial and vascular tissue proximal to the urethral orifice
which normally form the venter side of the penis by disproportionately strong proliferation
and make the urethral orifice shift distalward. Insufficient growth may disturb that
shift with the degree of deficiency determining the precise position of the urethral
orifice, size of the urethral delta and defect of the prepuce. Shortage and/or poor
organisation of these tissues explain curvature and, if asymmetrical, torsion, both
of which can occur also with minimal urethral deformity or as congenital ventral curvature
and torsion without hypospadias.
Keywords
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Article info
Publication history
Published online: September 07, 2006
Accepted:
May 30,
2006
Received:
March 29,
2006
Identification
Copyright
© 2006 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
