An enlarged prostatic utricle is often associated with hypospadias. To evaluate the relationship between the incidence of prostatic utricle and the degree of hypospadias, we performed retrograde urethrography and/or micturating cystourethrography on 280 patients with hypospadias. Prostatic utricles were demonstrated in 84 patients (27.5%) and the incidence increased according to the severity of hypospadias. The prostatic utricles were classified into four types from the standpoint of size and location of the opening of the utricle, and a direct relationship was demonstrated between the severity of hypospadias and increasing size of the prostatic utricle.
Fourteen patients with hypospadias were treated surgically for either an enlarged prostatic utricle (6) or vagina masculina (8). Six vaginae masculinae were removed by an extravesical abdominal approach. One enlarged prostatic utricle was removed by the perineal approach. Three enlarged utricles were removed by an abdominoperineal approach. The transtrigonal approach was recently used for three enlarged utricles and one vagina masculina in four patients. Surgical results in these 14 patients were satisfactory. One post-operative complication of transient mild bilateral vesicoureteric reflux was seen after a transtrigonal removal of an enlarged utricle. Potency was not affected in any approaches in four patients who were older than 12 years. The transtrigonal approach was found to be the best for good exposure of the lesion.
We reviewed 272 patients with hypospadias who were treated surgically to survey the complicated anomalies in these patients. Urogenital anomalies were recognized in 40 per cent of the 272 cases and extra-urogenital anomalies were noted in 9.2 per cent. Undescended testis was the most frequently seen anomaly, having been noted in 13.2 per cent of the 272 cases. The incidence of male vagina or utriculus masculinus was 11.8 per cent, prepenile scrotum 7.7 per cent and hypoplasia of the testis 6.6 per cent. Each of these 4 anomalies associated with hypospadias increased in incidence in proportion to the severity of the penile deformity. The necessity of systemic urological and hormonal examinations was emphasized, especially in cases of severe hypospadias.
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