HYPOSPADIAS By this name is designated the anomaly in which the urethra does not open at the point of the glans, but at some other point upon the lower side of the member. If the urethra opens at the base where the frenulum normally adheres, we speak of glandular hyposparlias. If the urethra opens at any other point upon the lower side of the penis in front. of the scrotum, we call it penile hypospadias or peni-scrotal hypospadias.
The highest degree of this anomaly is presented by perinea] hypo spadias (Fig. 16). These cases may look as if the individual were feminine, because the member is rudimentary in most cases. The discovery of testicles confirms the diagnosis. If these did not descend, the differential diagnosis between male and female may be impossible.
The etiology of the deformity consists in a. failure of the urethral end to develop, thereby forming only a furrow (the cyst. formation in the median line of the raphe of the external genitals, and the presence of penile flstuhe described by Englisch are connected with incomplete union of the genital folds). Glandular hypospadias represents an arrest
of development at the third to the fourth ketal month. Penile and perinea] hypospadias correspond to disturbances at an earlier stage.
The passage of urine is usually rendered difficult. in sonie cases to such an extent that complete atresia may be immitated. Incontinence in these cases, according to Karewski, is clue to the dropping of urine from the overflowing bladder.
The diagnosis is usually easy. In cases of seemingly complete retention of urine the differential diagnosis must be made from absolute atresia of the urethrfe. The finding of even a pin-point urethral orifice will reveal the true conditions (the treatment is purely surgical).