DR SHANDIP KUMAR SINHA
Pediatric Surgeon, Pediatric Urologist and Pediatric Laparoscopic Surgeon
Hypospadias for Medical Personal
Hypospadias - Management
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The goals of treatment are
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Reconstruct a straight penis with a meatus as close as possible to normal site.
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To allow a forward directed urine stream.
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Normal coitus.
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There are five basic steps for a successful hypospadias repair. These can be applied sequentially or in various combinations to achieve surgical success. These are
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Orthoplasty (straightening).
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Urethroplasty.
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Meatoplasty and Glanuloplasty.
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Scrotoplasty.
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Skin cover.
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Chordee release (Orthoplasty)
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Correction of penile curvature is performed while preserving the urethral plate.
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A tourniquet is placed at the base of penis and corpus cavernosum is injected with saline to see the exact degree of chordee.
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In about 25% of cases, the chordee is a true fibrous band or fan shaped are of fibrosis tethering the penis ventrally. When this fibrous tissue excised , the penis straightens.
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An incision is made in a circumferential manner around the corona and is carried well below the glans cap, just distal to the urethral meatus and down to the tunica albuginea of the corpora cavernosa.
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Proximal dissection is then achieved , freeing the fibrous plaques of the tissue adherent to the tunica albuginea.
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Sharp scissors/Surgical blade/bipolar cautry dissection is used, moving from side to side and proximally as the ventral curvature is released.
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At the end artificial erection test is performed to see the success of procedure.
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Urethroplasty
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Reconstruction of urethra can be performed in a single stage or in a two-stage procedure.
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As a general rule , a single-stage repair is appropriate for distal, mid shaft and proximal hypospadias without significant chordee.
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A two-stage repair is generally reserved for penoscrotal, scrotal and perineal hypospadias with chordee.
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To correct hypospadias and achieve a terminal meatus( urethroplasty), one may use one of the following tissues:
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Urethral plate
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moblisation
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tubularization
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Urethral plate (UP) augmentation
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Urethral plate (UP) replacement
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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
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Meatoplasty and Glanuloplasty.
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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.
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Scrotoplasty
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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
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skin cover
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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.
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