Nursing Care of Client with

Hypospadias
By Efris Kartika Sari
 Hypospadias is a common
abnormality in boys with an
incidence in the general population
estimated at 3 to 4 per 1000
live births (Thomas and Barker,
1997., Sanders, 2006).
 Definition
Hypospadias refers to a condition in
which the urethral opening is located
below the glans penis or anywhere
along the ventral surface (underside)
of the penile shaft.
Hypospadias is a congenital defect of the
penis in which the urinary tract opening,
or urethral meatus, is abnormally located
away from the tip of the penis.
 Classifications
Anterior: glanular, subcoronal.
Middle: distal penile, midshaft,
proximal penile.
Posterior: penoscrotal, scrotal,
perineal.
 In hypospadias, the opening of the
urethra may be anywhere along the
underside of the penis, from the
scrotum (the most severe kind) to
the tip (the least severe type).
 Aetiology
Genetic: failure of androgen
synthesis
Hormonal: progestin exposure, anti
androgenic activity
Environment: pollutant, terratogenic
agent
Pathogenesis
 Clinical Manifestations
The opening of the urethra (tube that
carries urine from the bladder to the
outside of the body) is not at the tip
of the penis.
The foreskin is not fully formed on
the underside of the penis.
The end of the penis looks bent.
Chordee/ ventral curvature.
 Treatment
Urethroplasty
Chordectomy
Surgical correction is necessary to repair
the defects (restore the urethral meatus
to its normal position on the glans,
correct penile curvature and create a
urethral that allows urination with a
controlled stream).
The repair is being done at progressively
younger ages between 6 to 18 months .
There are some complications that may
require more surgery:
Fistula: An abnormal opening can form
from the urethra to the skin
Meatal stenosis: A narrowing of the
urethral opening
Stricture: A narrowing of the urethra
Urethral diverticulum: An abnormal
pouch or sac branching out of the urethra
 Nursing Care
The children as hospitalized patients
need special care not only because
they are in a stage in which they built
their bodily systems but also because
they dont understand what happened
to them, where they are and who all this
strange people around them are.
Nurses should approach them properly
for gaining their trust and then take care
of them
 Preoperative teaching can relieve
some of their anxiety about the
future appearance and functioning of
the penis.
Postoperative care focuses on
protecting the surgical site from
injury.
 Encourage fluid intake to maintain adequate
urinary output and patency of the stent.
Accurate documentation of intake and output is
essential.
Pain may be associated with bladder spasms.
Anticholinergic medications such as oxybutynin
or hyoscyamine may be prescribed.
Acetaminophen may also be given for pain.
Antibiotics are often prescribed until the urinary
stent falls out.
THANK YOU