Hypospadias repair

Hypospadias is defined as the abnormal opening of the urethral meatus on the ventral side of the penis proximal to the tip of the glans penis.
Generally it has the
a) Abnormal opening of the urethra
b) Abnormal curvature of the penis commonly known as chordee
c) Dorsal hooding or foreskin

Types
a) Anterior :Glandular
Coronal
Sub coronal
b) Middle: Distal penile
Mid penile
Proximal penile
c) Posterior: Scrotal
Perineal
Penoscrotal
Surgical Technique:
The Hypospadias repair must be done before 2yrs of age
Trolly contains:
1. Marking pen
2. Meatal dilators
3. Tourniquet (Red rubber catheter, or vessel sling or umbilical tape)
4. BP handle 3and 7
5. Surgical blade 15 and 11
6. Paediatric toothed Adson’s forceps
7. Paediatric non toothed Adson’s forceps
8. Debakey forceps
9. Fine scissors curved
10. Fine scissor straight
11. Paediatric short scissor
12. Paediatric fine needle holder
13. Mosquito artery forceps curved 2 1/2”
14. Mosquito artery forceps curved 4”
15. Mosquito artery forceps curved 6”
16. Mosquito artery forceps straight 2 ½”
17. Mosquito artery forceps straight 4”
18. Mosquito artery forceps straight 6”
19. Kidney tray
20. SPC Trocar set
21. Syringe 10ml
22. Syringe 5ml
23. Peanut
24. Feeding tube 6Fr
25. Feeding tube 8 Fr
26. Vessel loop
27. Foleys catheter 6/8/10fr
28. Urobag

Suture Material:
29. 4-0 prolene
30. 6-0PDS
31. 4-0 vicryl
32. 5-0 catgut
33. Bipolar with paediatric forceps


The correction of hypospadias basically involves five principles as
a) Orthoplasty – Correction of chordee
b) Urethroplasty
c) Meatoplasty
d) Glanduloplasty
e) Skin correction

For anterior and middle hypospadias single stage repair is done whereas for posterior hypospadias as multistage technique is preferred.

Techniques of hypospadias repair:
1.FlipFlap Mathew technique
2.Tabularized graft technique
3.Onlay graft technique
4.Tubularized incised plate technique-Snodgrass Technique-Most common procedure used now a days.

Complication
a) Urethrocutaneous fistula
b) Stricture
c) Diverticulum
d) Persistant chordee.