الفهرس 
Anatomy of the penisOnly 14 pages are availabe for public view
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Abstract
Hypospadias refers to a penile defect in which the urethral orifice terminates on the ventral aspect of the penis proximal to the normal site. It may be anywhere from the tip of the penis to the perineum. Hypospadias may be associated with a variable degree of ventral curvature of the penis called chordee.
Hypospadias is one of the commonest congenital anomalies in males with an incidence of one in 300 live male births.
Hypospadias is classified into distal & proximal hypospadias. Proximal hypospadias represent 20% of the total number of cases. It is subdivided into mid penile, posterior penile, penoscrotal, scrotal & perineal hypospadias.
Hypospadias repair is currently performed on outpatient basis to reduce hospitalization costs, minimize the possibility of nosocomial infection. Early operation after one year of age is of great benefit up to the school age to achieve:
- Easy nursing of young infants.
- Reduction the psychological impact of surgery on the child and his parents.
Surgeon’s experience and adequate knowledge of plastic surgery principles are the most important factors affecting the outcome of hypospadias repair.
Fine or microsurgical instruments, delicate suture material (6-0 or 7-0) combined with good optical magnification (3.5 times) is recommended in all hypospadias surgery.
For avoidance of complications of electrocautery the use of bipolar electrocautery or a low setting of 5 watts coagulation for hemostasis is recommended.
No single technique is fit for one type of hypospadias, every patient has it proper selected operation.
Single stage operations are now well established especially after the introduction of artificial erection test and for those cases of anterior hypospadias, in particular.
For orthoplasty, it is recommended to start with penile degloving first, and assess straightness with artificial erection test. If chordee persists, either midline dorsal plication or excision of Nesbit ellipses should be performed. In the extremely severe condition, division of urethral plate or ventral grafting of the corpora cavernosa is the last resort.
No need for suprapubic or perineal urethrotomy drainage andusing instead transurethral stent which can be shortened to 2 days instead of 96 hours immobilization for imbibition and inosculation for graft urethroplasty with no associated increase in complication rate.
The use of balanic groove of Barcat provides an elliptical meatus whether used with an onlay graft or in a Mathieu flip flap. This technique consistently provided a cosmetically acceptable meatal appearance.
Lingual mucosa may provide a substitute in the absence of suitable tissue for urethroplasty.
In comparison of grafts and flaps, there is no significant difference regarding operative time, catheter duration, and complication rate. Furthermore, with ease of preputial graft harvest and presence of ENT team working at the same time for buccal grafts, operative time can be shortened.
Multilayered closure using meticulous surgical techniques should be undertaken, and a subcutaneous flap created by dissection from the lateral skin flap should be brought over the suture line to avoid opposing of suture lines and decreasing the incidence of recurrence of fistula.
Post operative care including good analgesia, antibiotics prophylactically proper method of urine diversion, proper dressing, care of urethral meatus has modified the postoperative rate of complications.
A longer follow up is recommended for assessing the development of delayed complications when utilizing grafts or flaps for hypospadias repair. Follow up after adulthood to assess sexual outcome is an interesting concept that needs to be evaluated further.
Digital photography is recommended as an essential part to assess the results of hypospadias repair as it provides an easy and objective means of evaluation.
We must consider the following on seeing a case of hypospadias:
1-Is it a fresh case or operated upon before.
2-Penis is curved or straight: If ventrally curved, is it due to skin tethering, minimal fibrous chordee or true fibrous chordee proximal to meatus or distal to it?
3-The site of meatus: Glanular, coronal, distal shaft penile, mid shaft penile, or penoscrotal.
4-Broad glans or narrow.
5-Deep glanualr groove (urethral plate) or not.
6-Type of meatus: Elastic, fish mouth, hypoplastic, stenotic.
7-Skin around meatus well developed, thin and scared.
In short we can say that, the goal of hypospadias surgery for every case is to have a normal penis (Functional and Cosmetic) and with minimal complications.