Urethroplasty

• Reconstruction of urethra can be performed in a single stage or in a two-stage procedure.

• As a general rule , a single-stage repair is appropriate for distal, mid shaft and proximal hypospadias without significant chordee.

• A two-stage repair is generally reserved for penoscrotal, scrotal and perineal hypospadias with chordee.

To correct hypospadias and achieve a terminal meatus( urethroplasty), one may use one of the following tissues:

• Urethral plate

  • moblisation

  • tubularization

• Urethral plate (UP) augmentation

• Urethral plate (UP) replacement

The  author prefer  tubularisation of the urethral plate as their preferred one-stage method in children with wide urethral plate(>9mm). However, whenever in doubt, authors prefer to augment urethra, either by perimeatal flap or lateral based flap, even in anterior hypospadias

Meatoplasty and Glanuloplasty.

• Creation of wide meatus at tip is aim in all hypospadias repair. the two steps, meatoplasty and glanuloplasty deal with this part of repair. However, it should be kept in mind that tight repair of glans can lead to meatal stenosis, needing dilatation a d many other complications. 

Scrotoplasty

• In hypospadias with pulled up scrotum, release of chordee leads to normal position of scrotum. in children with penoscrotal transposition, this step can be combined with or can be done in another step of hypospadias repair

skin cover

• skin rearrangement os done to either give circumcised look or prepucioplasty is done to give normal appearance. Prepucioplasty is associated with more chances of complication.