Special Surgical Procedures II
LESSON 3: Procedures in Genitourinary Surgery
Section v: operations on the scrotum, penis, and urethra
3-38
3-38. HYPOSPADIAS REPAIR
a. General. This surgery involves penile straightening and urethral reconstruction. Because the deformities are usually multiple, correction is usually accomplished in several stages, allowing several months to elapse between operations. The various techniques employed are for the purpose of providing a straight penis and establishing an effective urethral orifice.
b. Definitions.
(1) Hypospadias. A deformity of the penis and malformation of the urethral wall in which the urinary meatus is located on the underside of the penis, either short of its normal position at the tip of the glans or on the perineum or scrotum. This condition is often associated with chordee.
(2) Chordee. A downward bowing of the penis due to the congenital malformation of hypospadias with fibrous bands.
(3) Epispadias. A condition in which the urethral meatus is situated in an abnormal position on the upper side of the penis.
c. Operative Procedures.
(1) Chordee repair (Fraser or Nesbit technique).
(a) A transverse incision is made across the penis. Restricted fibrous tissue is dissected off the undersurface of the penis. Fine plastic scissors, a scalpel with blade number 10, and fine plastic tissue forceps are needed.
(b) With the penis held forward and the prepuce retracted, the skin is incised, and a dorsal quadrilateral flap is freed from the body of the penis.
(c) On each side, a narrow penile band of skin is divided.
(d) A transverse buttonhole is made to accommodate the head of the penis, which is threaded through it.
(e) The proximal edge of the buttonhole is sutured to the mucosa behind the corona. The preputial flap is trimmed and sutured to the raw area on the undersurface of the penis.
(f) An indwelling catheter is placed, and the wound is dressed.
(2) Urethral reconstruction.
(a) The urethra is dilated, and a Malecot catheter number 14 or number 16 Fr over a sound number 8 Fr is used to accomplish a perineal urethrostomy.
(b) On the ventral side of the penis, the Duplay flap is made to create the urethra. The edges of the flap are inverted and united over a catheter number 8 or number 10 Fr with interrupted chromic gut sutures number 5 - 0 or number 6-0 on Atraumatic needles.
(3) Penile reformation.
(a) The scrotal flaps are made prior to lifting the penis from the scrotum. A catheter is placed in the penile urethra. By dissection, the penis with its established new urethra is lifted off the scrotum.
(b) The flaps are sutured, providing the proper penoscrotal angle.
(c) The scrotal fascia of the flap may be sutured.
(d) A catheter may be placed. The wound is dressed.
