Primary Hypospadias

Hypospadias can be easily recognized at birth by a pediatrician due to incomplete prepuce, exposed glans, bent penis (chordee) or abnormal urinary opening itself. Usually these babies are referred to a Hypospadias Surgeon in the first month of life for proper planning of hypospadias corrective surgery.

This referral is very important and should be sent to a surgeon well trained in doing hypospadias repair surgery. Whether it is a Pediatric Urologist, a Pediatric Surgeon or a Urologist, the surgeon should have an interest and dedication in the science and art of management of hypospadias. Pediatric Urology Section of American Academy of Pediatrics Recommends that the results of Hypospadias Surgery are best in hands of surgeons who do atleast 40-50 cases a year.

First Hypospadias Surgery done by a well trained surgeon is the best single indicator of good long term outcome in Hypospadias. Subsequent hypospadias repairs if the previous repair/s have failed carry a higher failure rate.

First surgery outcomes improve with:

  1. Proper case selection- There are more than 100 techniques described for hypospadias repair. Every child with hypospadias has a different anatomy. The proper choice of surgical technique based on subtle variations in anatomy is the prime factor influencing surgical outcome of hypospadias treatment.
  2. Dedicated setup: People (full team- surgeon/ anesthesiologist, nurses, assistants, junior doctors) should be trained in pre-op and post-op management of children for hypospadias surgery.
  3. Dedicated instruments: Sharp, precise, new, microsurgery instruments dedicated towards only hypospadias treatment lead to better surgical results. These instruments are very delicate and should not be used for other surgeries
  4. Magnification aids during surgery: Use of proper magnification by wearing maginifying loupes while doing surgery aids in identifying proper tissues and also placing the stitches properly. Also, bleeding can be minimized.
  5. Protocol based approach: Following same steps over and over in last few years for hundreds of hypospadias surgeries have allowed us to deliver best results of hypospadias surgery.
  6. Day care surgery: 95% of children are sent home the day of hypospadias surgery minimizing infections, poor eating issues and happier kids. This results in better outcomes of hypospadias surgery.

Techniques used for Primary Hypospadias Reapir Surgery

Though there are many techniques for hypospadias repair procedure, mastery of a few and judicious application in properly selected cases leads to good outcomes.

Single Stage repairs:

  1. Snodgrass urethroplasty (also called Tubularised Incised Plate urethroplasty)
  2. Transverse Island Onlay Flap urethroplasty (also called Onlay Flap Urethroplasty) - Case 2
  3. Transverse Island Onlay Flap urethroplasty (also called Onlay Flap Urethroplasty) - Case 3
  4. Transverse Island Onlay Flap urethroplasty (also called Onlay Flap Urethroplasty) - Case 4
  5. Prepucial tube urethroplasty
  6. Modified Koyanagi urethroplasty

Staged Urethroplasty - Thiersch Duplay urethroplasty

 



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