Incidence

One in 125 boys has hypospadias. In the United States, a study reported that hypospadias was the most common congenital anomaly among whites. The incidence has been rising during the 1970s and 1980s.

Classification

The anatomic classification of hypospadias recognizes the level of the meatus without considering curvature. A newer classification includes the site of the urethral meatus (before and after chordee correction), the prepuce condition (incomplete or complete), glans shape (cleft, incomplete cleft, or flat), the width of the urethral plate, degree of penile rotation, and presence of scrotal transposition.

Using the general classification, surgeons are able to conduct multi-centre studies to evaluate different techniques of repair.

Fig. 1: Classification of hypospadias according to meatus location (4 grades)

Fig. 2: Classification of glans configuration in hypospadias

Glans Types

• Cleft glans: Deep groove in the glans center with narrow urethral plate projecting to the tip.
• Incomplete cleft glans: Partial glans split with a shallow groove and variable plate projection.
• Flat glans: Urethral plate ends short of the glans penis with no glanular groove; possible chordee, especially in proximal hypospadias.

Fig. 3: Risk evaluation for hypospadias repair (birth to 7 years, optimal at 3–18 months)

Fig. 4: General classification: multi-centre evaluation of surgical techniques