Surgery MCQs Q8

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PEDIATRIC SURGERY • UROLOGY

A 27-year-old man presents to the emergency department with dysuria and a distorted urinary stream. On examination, the external urethral meatus is abnormally located on the ventral (inferior) surface of the glans penis. Urinalysis shows evidence of bacterial infection.

What is the most likely associated feature of this congenital anomaly?

A Associated with undescended testes in >50% of cases

B Associated with chordee (ventral curvature of the penis)

C Rare fusion defect of posterior urethra

D Occurs sporadically without familial inheritance

E Most common location is penoscrotal

Chordee Association. The patient has Hypospadias (ventral meatus). This is frequently associated with Chordee, a ventral curvature caused by fibrous bands or shortened ventral skin.

Decoding Clue

1

CLUE "Abnormal ventral meatus + distorted stream"

TRANS Diagnosis is Hypospadias.

2

CLUE "Ventral (Inferior) surface"

TRANS Look for ventral-side associations (Chordee, Hooded Prepuce).

Explanation

A. Undescended testes: Occurs in less than 10% of cases (usually < 5%). More common in proximal severe types, but nowhere near 50%.

C. Posterior urethra: Hypospadias is a defect of the anterior urethra (fusion of the urethral folds), not the posterior portion.

D. Familial inheritance: There is a significant genetic/familial component; brothers of affected individuals have a ~20% risk.

E. Most common location: Distal (glanular or subcoronal) is the most common (~70%), not the severe penoscrotal type.

🧠 High-Yield Pearls

Feature	Hypospadias	Epispadias
Meatus Location	Ventral (Inferior)	Dorsal (Superior)
Curvature	Chordee (Ventral)	Dorsal Curvature
Foreskin	Dorsal Hooded Prepuce	Cleft Foreskin
Association	Androgen signaling defects	Bladder Exstrophy

Integrated Clinical Questions

1. Most common congenital penile anomaly?

Answer: Hypospadias.

2. Most common location of the hypospadiac meatus?

Answer: Glanular (Distal) type.

3. What is the embryological defect in hypospadias?

Answer: Failure of the urethral folds to fuse completely on the ventral surface.

4. What is a 'Dorsal Hooded Prepuce'?

Answer: Incomplete foreskin development where skin covers the dorsum but is absent ventrally. Note: Neonatal circumcision is contraindicated because this skin is needed for repair.

⚡ Exam Pearls

• Hypospadias = Ventral (Inferior) + Chordee.
• Epispadias = Dorsal (Superior) + Bladder Exstrophy.
• Contraindication: NEVER circumcise a baby with hypospadias before urology consultation.

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