Clinical Oriented Classification of Hypospadias: A Useful Guide to Select Appropriate Surgical Procedure
摘要
To design a clinical classification for hypospadias that could facilitate surgeons in planning and selecting appropriate surgical procedure for the case under consideration. To assign broad categories and sub-categories based upon structural, functional and pathological characteristics of both virgin (fresh) and failed (re-do) hypospadiacs. The photographic record and personal experience of surgical management of 363 fresh and 158 re-do hypospadias between 2004 - 2016 in“Hypospadias and VVFs Clinic” of Department of Burns and Plastic Surgery, Postgraduate Institute of Medical Sciences (PGIMS), Rohtak constituted the material for this retrospective study. Based upon structural, functional and pathological characteristics of clinical importance, such hypospadiacs were divided in two broad categories i.e., simple hypospadias (SH) and complex hypospadias (CH), and eight sub-categorized i.e., SHa, SHb, SHc, SHd and CHa, CHb, CHc, CHd respectively. This facilitates the operating surgeon in choosing an appropriate simple or complex, single or multi-staged surgical procedure for a given case. The surgeon, after having known the category of hypospadias and going through the table, would be able to make up mind towards choosing best suited surgical procedure for a given case. The newly designed classification will mentally prepare the surgeon to a great extent towards making better pre-operative planning and choosing an appropriate surgical procedure for the given case. However, the final surgical procedure will be decided only after detailed history and loco-regional examination to detect all characteristics of hypospadias and associated morbidities that impact planning and selection of best surgical procedure.