HYPOSPADIA
In the congenital malformation Hypospadia the urethra is incomplete with a ventral external orificium (opening of the urethra on the underside of the penis) proximal to the normal anatomical position and absence of a part of the distal urethra. In males it is accompanied by Chordé – a dense fibrotic core replacing the lacking distal urethra – which causes bending of the penis, more severely with erection.
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In females the diagnosis is not as obvious as in the males, and the condition often passes unnoticed unless the defect is a major one causing incontinence.
The reconstructive surgery can be done in one, two or three stages. It involves excision of the chordé, reconstruction of a urethral tube and skin coverage. I prefer a one stage procedure at the age 3 – 5 years. At that age it is technically far much easier than in the newborn or infant.
The fibrotic tissue – the Chordé – must be excised completely. That brings the urethral orificium even more proximal and widens the urethral defect.
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Fortunately the foreskin is most often present as boys with hypospadia are usually not circumcised. The foreskin is grasped with forceps or sutures and kept tight. A quadrant of the skin is cut, but left attached to the subcutaneous tissues.
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The skin flap is sutured together with absorbable sutures making a tube with the skin lining inside.
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A transverse cut is made at the base of the foreskin and the glans is brought through that incision bringing the skin tube into position to replace the absent distal urethra. The skin tube is anastomosed to the proximal urethra and sutured in place on the glans using absorbable sutures
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Skin suture completes the procedure
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The catheter is removed after 2 weeks unless there is leakage from a fistula in which case the drainage has to be extended until it dries up or a second repair is done
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