A new approach in hypospadias repair.
ABSTRACT The field of hypospadiology remains full of challenges in the search for new and better solutions. In recent years, our concept has involved being very radical in penile reconstructive surgery, using an aggressive approach. The penile disassembly technique, either complete or incomplete, is used successfully in epispadias repair. We began using penile disassembly in hypospadias repair in November 1995. The technique was applied on 112 patients aged from 9 months to 32 years. Indications were: hypospadias with severe penile curvature (especially when the curvature was located in the distal third of the corpora cavernosa), chordee without hypospadias, and small penises with hypospadias. The principle of the technique involves separation of the penis into its component parts: the glans cap with neurovascular bundle (dorsally) together with the nondivided or divided urethra and urethral plate (ventrally) and the corpora cavernosa. This maneuver enables an excellent correction of curvature, especially if it is located in the distal third of the corporal bodies and glans tilt. With this technique, substitution urethroplasty can be avoided or its extent, decreased. It enables penile enlargement, above all its lengthening, which is a significant gain in small penises with hypospadias. The patients were followed for 3-23 months (mean 16 months). Straightening of the penis was achieved in all cases without recurrence of curvature. In 37 patients penile disassembly combined with extensive urethral mobilization solved the problem of hypospadiac meatus without the need to form a neourethra. Complications related to urethroplasty included four urethral stenoses, two fistulas, and three diverticula. There was no injury to the neurovascular bundle and urethra. Sensitivity and erection were preserved in all patients. Penile disassembly is an optimal technique for repair of hypospadias with severe curvature and small hypospadiac penises. Real penile augmentation is possible with this technique.
- The Journal of Urology 09/2000; 164(2):449-50. DOI:10.1016/S0022-5347(05)67387-9 · 3.75 Impact Factor
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ABSTRACT: We describe a technique of proximal hypospadias correction that involves freeing the proximal normal bulbar urethra from perineal attachments to lengthen the ventral penis and decrease chordee. Correction was performed in 9 patients with a mean age of 11.5 months who had proximal hypospadias and severe chordee that was perineal in 2, mid scrotal in 6 and penoscrotal in 1. After the penis was degloved the bulbar urethra was detethered to or beyond the perineal body without lifting the urethra from the corpora cavernosa. Any remaining penile chordee was corrected and the urethral plate was transected only when chordee persisted. When the urethral plate was intact and the penis straight, tubularized incised plate urethroplasty was done to correct hypospadias in 1 stage. Otherwise 2-stage repair was performed. Using this maneuver penile straightening was achieved in 2 of the 9 patients, resulting in a glanular urethral or penoscrotal meatus. Dorsal plication sutures required in 4 cases resulted in a mid shaft and penoscrotal meatus in 1 and 3, respectively. Residual chordee in the remaining 3 patients necessitated division of the urethral plate and 2-stage repair despite aggressive mobilization of the proximal urethra. Simultaneous tubularized incised plate urethroplasty was then performed in the 4 penoscrotal and 1 mid shaft meatus. All 6 patients who underwent a successful 1-stage procedure have excellent cosmetic results, while 1 required meatotomy. No fistula or chordee was present at a mean of 13.8 months of followup (range 3.9 to 27.1). This safe, rapid technique may compensate for significant penile tethering and chordee in a subpopulation of patients with proximal hypospadias, such as 6 of the 9 in our study. It also allows successful tubularized incised plate urethroplasty to be done simultaneously.The Journal of Urology 11/2000; 164(4):1347-9. DOI:10.1016/S0022-5347(05)67194-7 · 3.75 Impact Factor
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ABSTRACT: Penile curvature is a spectrum of disease affecting boys with and without hypospadias. The etiology of chordee includes skin tethering, fibrotic bucks or dartos fascia, corporeal body disproportion and rarely a fibrotic urethra. Several surgical techniques (plication, excision, and graft insertion) are currently employed to repair penile curvature. Recent neuroanatomical studies of the developing fetal penis have shown that the dorsal nerve branches from the 11 and 1 o'clock positions to the 5 and 7 o'clock positions, being absent in the midline. Since the neuroanatomy is similar in both the hypospadiac and normal penis, we now recommend performing penile straightening in both hypospadiac and non hypospadiac patients with significant curvature by the placement of plication sutures at the 12 o'clock position. Placement of dorsal midline plication sutures corrects curvature without risk to the underlying nerve structures.Urologic Clinics of North America 06/2002; 29(2):277-84, v. DOI:10.1016/S0094-0143(02)00044-7 · 1.35 Impact Factor