A child with Severe Hypospadias - Prepucial tube urethroplasty

Master VM, 1.5 years old boy was brought to the clinic from Surat with severe hypospadias. On examination the urinary opening was scrotal in location.


There was significant chordee also. The final diagnosis thus was Scrotal Hypospadias with chordee. Everywhere else he had been advised a staged urethroplasty requiring 3 surgeries.

A single stage urethroplasty was planned. As first step, the penis was degloved to obviate the chordee. Even after degloving, significant chordee was still seen. A 12 O’clock tunica albuginea plication stitch was taken and penis was straightened. The chordee correction test showed no residual chordee.

A decision was made to make a tube from the dorsal prepuce and use it as a new urethra by rotating it towards underside of penis. This is called a single stage “prepucial tube urethroplasty” one of the complex repairs for severe hypospadias.

 

A prepucial flap was outlined and was harvested with good dartos blood supply. This was then brought ventrally and sutured to midline tunica albuginea with PDS to lay a base for tubularisation. Then this flap was tubularised over a 7Fr catheter as a new urethra Glans repair and a new urethral opening was made. The prepuce was split in midline and brought towards underside to cover the new urinary passage.



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