Epispadias&Hypospadias

A nurse is assessing a 6-month-old male infant with hypospadias. Which assessment finding would the nurse expect to observe?

1 The urethral opening is located on the dorsal surface of the penis
2 The urethral opening is located on the ventral surface of the penis ✓ 정답
3 The foreskin is completely absent from birth
4 The penis curves upward during erection

해설

Hypospadias is characterized by a urethral opening on the ventral surface of the penis. Other options describe dorsal location (epispadias), absent foreskin (not typical), or upward curvature (not specific to hypospadias).

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Understanding Hypospadias

Hypospadias is a congenital condition in which the urethral opening (meatus) is located on the ventral surface (underside) of the penis, rather than at the tip. This occurs due to incomplete fusion of the urethral folds during fetal development. The condition is one of the most frequent congenital anomalies in male neonates . The location of the meatus can vary along the ventral shaft, from the glans to the perineum, and is often accompanied by a hooded dorsal foreskin and chordee (ventral curvature of the penis).

Analysis of Assessment Findings

The correct assessment finding for an infant with hypospadias is that the urethral opening is located on the ventral surface of the penis.

- Option 1 (Dorsal surface): A urethral opening on the dorsal surface describes epispadias, a different congenital anomaly, not hypospadias.
- Option 2 (Ventral surface): This is the defining anatomical feature of hypospadias. The incomplete fusion of the urethral folds results in the meatus opening anywhere along the ventral midline .
- Option 3 (Absent foreskin): The foreskin is not completely absent in hypospadias. Typically, it develops abnormally, resulting in a "hooded" appearance where the foreskin is present on the dorsal side but absent on the ventral side.
- Option 4 (Upward curvature): The curvature associated with hypospadias is chordee, which is a ventral (downward) curvature, not an upward curve. This is caused by fibrous bands of tissue that tether the penis downward.

Clinical Significance and Nursing Implications

The assessment of hypospadias is critical because it directly impacts nursing care and patient education. A key nursing intervention is to avoid circumcision immediately after birth. The dorsal hooded foreskin is often used as a tissue graft during surgical repair, making its preservation essential. Corrective surgery is generally advised within the first 6 to 18 months of life . The goals of surgical repair, such as the tubularized incised plate (TIP) urethroplasty, are to create a functional neourethra at the tip of the glans, correct any chordee, and achieve a cosmetically normal appearance. To minimize postoperative complications like urethrocutaneous fistulas, a second-layer coverage using tissues such as dartos fascia or a tunica vaginalis flap is performed over the neourethra . Postoperative care focuses on maintaining the patency of a urinary catheter or stent, preventing infection, and managing bladder spasms.

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A nurse is assessing a 6-month-old male infant with hypospadias. Which assessment finding would the nurse expect to observe?

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