Hypospadias surgery can be carried in one or multiple steps depending on the severity of the disease. From one to the following step, patients must wait three or more months.
Surgery is usually carried under general or spinal anesthesia. For urethral reconstruction many techniques can be used. When the severity of hypospadias is significant (e.g. the meatus is at the basis of the penile shaft), a buccal mucosa graft can be used for reconstructing the urethra.
The most common way to repair distal hypospadias is the tubularized incised plate (TIP) repair, which is more commonly known as the “Snodgrass repair”. Briefly, the penis is degloved, longitudinal incisions are made along the visible junction of the glans wings to the distal urethral plate. A longitudinal incision is performed on the midline of the distal urethral plate, and then the urethra is tubularized over a catheter. The glans wings are closed over the urethra.
In case of proximal hypospadias, staged repair is recommended. The two-stage buccal mucosa graft urethroplasty followed the principles described by Bracka. Briefly, in the first stage the
short urethra that caused severe ventral curvature is excised/transected proximally to lengthen and straighten the penis. A buccal mucosa graft is quilted on the penile shaft and anchored to the proximal meatus. After 3/6 months, the buccal mucosa graft is tubularized to reconstruct the urethra up to the glans.
Penile curvature is re-assessed at the time of surgery. Normal saline solution is injected into the corpora cavernosa using a 23-gauge butterfly needle until full erection is achieved. Tourniquet is avoided because it eventually masks a curvature, if positioned at the point of bending. Curvature correction is achieved with different techniques including lengthening procedure (relaxing incision and/or buccal graft augmentation) or dorsal plications.
When the urethroplasty is performed and the curvature is corrected, penile skin is reconstructed with great care to achieve excellent aesthetic results. A catheter is placed at the end of surgery and it is left in place for 1 or more weeks, depending on the surgery. Dressing is also important after surgery to avoid swelling and edema that can compromise the healing of the skin. Hospital stay is usually for one or two days. Nevertheless, patients are followed-up after discharge until the catheter is removed.
