Proximal division of the urethral plate in staged hypospadias repair

Earl Y. Cheng*, Bradley P. Kropp, John C. Pope IV, John W. Brock, Michael Ritchey

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

Purpose: We describe a new technique for staged hypospadias repair in which the urethral plate is divided proximally at the time of the first stage. Materials and Methods: A total of 14 patients with proximal hypospadias associated with severe chordee were operated on using a new staged technique. At the time of the first stage the urethral plate was divided proximally at the level of the hypospadiac meatus. In 8 of 14 patients the intact plate was then incised and tubularized with the Snodgrass technique. In 6 patients the plate was tubularized at the time of the second stage. Correction of chordee was accomplished with dorsal plication and/or corporal body grafting. Byar's flaps were used to fill in the residual gap between the proximal hypospadiac meatus and the newly tubularized neourethra. The transposed flaps in the area of the urethral defect were then tubularized at the second stage. Results: Followup ranged from 6 months to 3 years. Complications included a proximal pinpoint fistula and diverticulum in 1 case. An additional patient also had formation of a mild diverticulum that has not required surgical revision. No patients have had any evidence of distal urethral stricture formation. Conclusions: Proximal division of the urethral plate and application of the Snodgrass procedure to the staged repair of hypospadias have resulted in improved functional and cosmetic results. The major advantage of this new technique is preservation and use of the native urethral plate in the glans and subcoronal area. When complications occur with this technique, they are less severe compared to those of the traditional staged approach.

Original languageEnglish (US)
Pages (from-to)1580-1584
Number of pages5
JournalJournal of Urology
Volume170
Issue number4 II
DOIs
StatePublished - Oct 1 2003

Keywords

  • Hypospadias
  • Penis
  • Urethra

ASJC Scopus subject areas

  • Urology

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