A boy with hypospadias with thin urethra

A.S., 9 months old child was brought with abnormal curvature of penis and abnormal urinary opening- a condition called hypospadias (means urinary opening on downside of penis). The abnormal curvature is called chordee. On examination – urethral opening was situated on the underside of penis and the terminal part of urethra was very thin and abnormal for whole length of penis. This is called hypoplastic urethra. The child was planned for a single stage chordee correction& urethroplasty.

During chordee correction surgery, hypoplastic urethra was excised and the penis was straightened. After laying open of the thin urethra, the opening was at proximal penile region making the child effectively a child having proximal penile hypospadias. An onlayprepucial flap was made from the excess skin on the upper side of penis – this technique of Single Stage Urethroplasty is called Transverse Island Flap Urethroplasty. The flap was rotated towards the underside of penis for making a new urinary pipe. The baby was discharged the next day after urethroplasty surgery and double diaper was used for draining the catheter.

Dressing was removed five days after surgery and the catheter was removed after 10 days in clinic.

At 3 months follow-up the penis has healed well and now looks like a normal circumcised penis.

Clinical Picture showing thin urethra with opening just below the tip of penis- deceptively mild hypospadias

Penis after degloving and excising the thin distal urethral wall -actually a severe hypospadias

Transverse island flap harvested from the dorsal prepuce

At the completion of surgery- there is no chrodee and the opening is the tip of penis

Important points about hypospadias:

• Hypospadias is one of the most common anomalies worldwide.
• The best age for corrective hypospadias urethroplasty surgery is between 6-15 months.
• Most of the hypospadias can be corrected with a single stage surgery, rarely if the penis is too curved (chordee) or the skin is short or there is an associated disorder of sex differentiation, a two or a three stage surgery may be required.
• Onlay flap urethroplasty was first described by Dr Asopa in India and now is done for severe hypospadias by top and best expert pediatric urologist surgeons.
• The success rate of Single Stage Urethroplasty in correctly chosen cases is more than 95%.
• Most common post-op problems (5%) are infection and formation of a fistula requiring a second surgery
• www.hypospadiasfoundation.com

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Watch videos of Onlay flap urethroplasty - Hypospadias Surgery by Dr A.K.Singal

Proximal Penile Hypospadias surgery vide by Dr A.K.Singal

Scrotal Hypospadias Surgery Video by Dr A.K.Singal