A method of hypospadias repair

Summary The treatment of hypospadias requires the release of chordee and the reconstruction of a new urethra to provide for a satisfactory sexual function and normal micturition. A technique is described in two stages. In the first stage a large dorsal apron flap of prepuce skin is developed by a pericoronal incision. The chordee is released well beyond the urethral opening. A button-hole incision allows the prepuce flap to be reflected to the ventral surface. The distal part of this flap is formed into a skinlined tube with raw surface outward and pulled through a transglandular tunnel incision to the tip of the glans while rotating it 180 degrees. The ventral surface is closed. After three to six months, the penis presenting with a subglandular opening of the tube and the proximal hypospadiac urethra, the final reconstruction is undertaken. The excess ventrally shifted skin from the first stage between both orifices is incised by means of two parallel incisions and tubed to form one continuous urethral skin tube. A multi-layer closure burying the tube completes the procedure. The technique has given very encouraging results.