Iatrogenic Hypospadias – Is this preventable?

Background Iatrogenic hypospadias is an avertible deformation to the ventral part of male urethra caused by downward pressure of an indwelling urethral catheter. Whereas it is not a life-threatening complication, most patients with such condition find the penile appearance appalling. Case Report An 86-year-old man who is being managed for bladder outlet obstruction secondary to benign prostate enlargement and he has been using urethral catheter for about a year. Clinical examination revealed stable vital signs except for elevated blood pressure (173/94mmHG) and catheterized penis with a cleft on the ventral part extending from the external urethral meatus to the subcoronal region. The blood work up was essentially normal except for mild thrombocytopenia. Pus culture yielded multidrug resistant staphylococcus aureus and urine culture grew mixed bacterial growth. He was treated with urinary antiseptics which resulted in improved clinical state and was discharged second day of admission for further care as outpatient. Conclusion Iatrogenic hypospadias is a relatively uncommon complication of prolonged urethral catheterization that is preventable by appropriate choice of catheter size, securing urethral catheter the right way and suprapubic cystostomy when prolonged catheterization is inevitable.