Surgery MCQs Q8

A 27-year-old man presents to the emergency ward with burning urination and a distorted urinary stream. On examination, the external urinary meatus is displaced inferiorly on the glans. Urine analysis shows bacteriuria.

Which of the following statements about this anomaly is most accurate?

A. Associated with undescended testes in more than 50% of cases

B. Associated with chordee (ventral curvature of the penis)

C. A rare fusion defect of the posterior male urethra

D. Occurs sporadically, without evidence of familial inheritance

E. The most common location is penoscrotal

✅ Correct Answer:

B. Associated with chordee (ventral curvature of the penis)

Explanation of Correct Answer

• 🔹 Chordee: Ventral curvature of the penis is commonly associated with hypospadias, especially in proximal forms, and can also be present in distal types.
• 🔹 Hallmark: The ventral displacement of the meatus is the defining characteristic of hypospadias.
• 🔹 Symptoms: Abnormal urinary stream and secondary infection (bacteriuria) are typical clinical manifestations.

Explanation of Wrong Options

A. Associated with undescended testes >50%: Cryptorchidism is associated with hypospadias but occurs in <10–20% of cases, mainly in severe/proximal hypospadias, not >50%.

C. A rare fusion defect of posterior male urethra: Posterior urethral fusion defects (like posterior urethral valves) are distinct anomalies, not related to distal hypospadias.

D. Occurs sporadically, without evidence of familial inheritance: Hypospadias can occur sporadically but also has a genetic/familial component in ~7–10% of cases.

E. Most common location is penoscrotal: Distal hypospadias (glanular/subcoronal) is most common (~70–80%). Penoscrotal/proximal hypospadias is less frequent.

🧠 High-Yield Points

Most common type → Distal hypospadias
Key associations → Chordee, sometimes cryptorchidism
Clinical concern → Distorted urinary stream, recurrent infection
Management → Surgical correction in childhood

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💡 Quick Clinical Challenge:

A newborn is diagnosed with hypospadias. The parents ask about immediate management.

Your Challenge:

1. What common neonatal procedure is contraindicated in infants with hypospadias?
2. What is the rationale for this contraindication?

Show Answer

✅ Answer:

1. Circumcision.
2. The preputial skin (foreskin) is often needed as a graft material for the surgical urethroplasty.