Penile Hypospadias Reconstruction Workup

  • Author: Fabio Santanelli, MD, PhD; Chief Editor: Jorge I de la Torre, MD, FACS   more...
 
Updated: May 22, 2012
 

Laboratory Studies

  • Obtain a complete blood cell (CBC) count for infants and elderly persons.
  • In severe forms of virilization failure, determine sex assignment with karyotype analysis and blood and urinary hormone levels.
Next

Imaging Studies

  • Perform ultrasonography to assess the normality of the upper urinary system in the presence of other organ system anomalies, syndromic patients, or ambiguous genitalia.
  • Obtain a chest radiograph if indicated by examination findings or the patient's history.
Previous
Next

Other Tests

  • Obtain an ECG per anesthesia or operating room guidelines.
Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Fabio Santanelli, MD, PhD  Associate Professor of Plastic Surgery, Sapienza University of Rome School of Medicine; Chief of Plastic Surgery Unit, Sant'Andrea Hospital, Rome

Fabio Santanelli, MD, PhD is a member of the following medical societies: American Society of Plastic and Reconstructive Surgery, European Association of Plastic Surgeons, International Confederation for Plastic and Reconstructive Surgery, Osservatorio Nazionale Identità di Genere, Società Italiana di Microchirurgia, and Swedish Associations of Plastic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Francesca Romana Grippaudo  MD, Assistant Professor, Department of Plastic Surgery, Faculty of Medicine and Psycology, Sapienza University of Rome, Italy

Francesca Romana Grippaudo is a member of the following medical societies: International Confederation for Plastic and Reconstructive Surgery and Italian Society of Plastic Reconstructive Surgery and Aesthetics

Disclosure: Nothing to disclose.

Specialty Editor Board

Dennis P Orgill, MD, PhD  Professor of Surgery, Harvard Medical School; Associate Chief of Plastic Surgery, Brigham and Women's Hospital

Dennis P Orgill, MD, PhD is a member of the following medical societies: American Medical Association, American Society for Reconstructive Microsurgery, Massachusetts Medical Society, and Plastic Surgery Research Council

Disclosure: Kinetic Concepts, Inc. Consulting fee Consulting; Brigham and Women's Hospital Royalty None; Kinetic Concepts, Inc. Speaking Services Agreement Speaking and teaching

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jorge I de la Torre, MD, FACS  Professor of Surgery and Physical Medicine and Rehabilitation, Chief, Division of Plastic Surgery, Residency Program Director, University of Alabama at Birmingham School of Medicine; Director, Center for Advanced Surgical Aesthetics

Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama

Disclosure: Nothing to disclose.

Nicolas (Nick) G Slenkovich, MD  Director, Colorado Plastic Surgery Center

Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Jorge I de la Torre, MD, FACS  Professor of Surgery and Physical Medicine and Rehabilitation, Chief, Division of Plastic Surgery, Residency Program Director, University of Alabama at Birmingham School of Medicine; Director, Center for Advanced Surgical Aesthetics

Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama

Disclosure: Nothing to disclose.

References

  1. Smith ED. The hystory of hypospadias. Pediatr Surg Int. 1977;21:81-85.

  2. Browne D. An operation for hypospadias. Lancet. 1946;1:141-151.

  3. Hinderer U. Hypospadias. Rev Esp Chir Plast. 1968;1:53-58.

  4. Toksu E. Hypospadias: one-stage repair. Plast Reconstr Surg. Apr 1970;45(4):365-9. [Medline].

  5. Duckett JW Jr. Transverse preputial island flap technique for repair of severe hypospadias. Urol Clin North Am. Jun 1980;7(2):423-30. [Medline].

  6. Koyanagi T, Nonomura K, Kakizaki H, et al. Experience with one-stage repair of severe proximal hypospadias: operative technique and results. Eur Urol. 1993;24(1):106-10. [Medline].

  7. Standoli L. Vascularized urethroplasty flaps. The use of vascularized flaps of preputial and penopreputial skin for urethral reconstruction in hypospadias. Clin Plast Surg. Jul 1988;15(3):355-70. [Medline].

  8. Scuderi N, Campus GV. A new technique for hypospadias one-stage repair. Chir Plast. 1983;7:103-109.

  9. Fossum M, Skikuniene J, Orrego A, Nordenskjöld A. Prepubertal follow-up after hypospadias repair with autologous in vitro cultured urothelial cells. Acta Paediatr. Mar 8 2012;[Medline].

  10. Avellán L. Morphology of hypospadias. Scand J Plast Reconstr Surg. 1980;14(3):239-47. [Medline].

  11. Blair VP, Byers LT. Hypospadias and epispadias. J Urol. 1938;40:814-816.

  12. Castanon Garcia-Alix M, Martin Hortiguela ME, Rodo Salas J. Complications in hypospadias repair:20 years of experience. Cir Pediatr. 1995;8:118-122.

  13. Dayanc M, Tan MO, Gokalp A, et al. Tubularized incised plate urethroplasty for distal and mid-penile hypospadias. Eur Urol. Jan 2000;37(1):102-5. [Medline].

  14. Devine CJ Jr, Horton CE. Hypospadias repair. J Urol. Jul 1977;118(1 Pt 2):188-93. [Medline].

  15. Duckett JW. MAGPI (meatoplasty and glanuloplasty): a procedure for subcoronal hypospadias. Urol Clin North Am. Oct 1981;8(3):513-9. [Medline].

  16. Ghali AM, el-Malik EM, al-Malki T, et al. One-stage hypospadias repair. Experience with 544 cases. Eur Urol. Nov 1999;36(5):436-42. [Medline].

  17. Hayashi Y, Kojima Y, Mizuno K, et al. The modified Koyanagi repair for severe proximal hypospadias. BJU Int. Feb 2001;87(3):235-8. [Medline].

  18. Johanson B, Avellán L. Hypospadias. A review of 299 cases operated 1957-69. Scand J Plast Reconstr Surg. 1980;14(3):259-67. [Medline].

  19. Minevich E, Pecha BR, Wacksman J, et al. Mathieu hypospadias repair: experience in 202 patients. J Urol. Dec 1999;162(6):2141-2; discussion 2142-3. [Medline].

  20. Santanelli F. Distally based turnover flap and preputium plasty for distal hypospadias repair: a preliminary report. Ann Plast Surg. Nov 1992;29(5):413-6. [Medline].

  21. Santanelli F. Vertical preputial flap with double skin island for correction of hypospadias with severe recurvatum. Ann Plast Surg. Sep 1994;33(3):305-12. [Medline].

  22. Santanelli F, D'Andrea F, Savanelli A, et al. Reconstruction of hypospadias with a vertical preputial island flap. A follow-up study of 127 patients. Scand J Plast Reconstr Surg Hand Surg. 1990;24(1):67-73. [Medline].

  23. Scuderi N, Tirone L, D'Andrea F. Terapia dell'ipospadia peniena e revisione di oltre 100 casi trattati con tecnica personale. Rivista Italiana di Chirurgia Plastica. 1988;20:339-358.

  24. Soygur T, Filiz E, Zumrutbas AE, et al. Results of dorsal midline plication in children with penile curvature and hypospadias. Urology. Oct 2004;64(4):795-8; discussion 798. [Medline].

 
Previous
Next
 
Left: External genitalia during the undifferentiated stage. Middle: Male external genitalia at ninth week of intrauterine life. Right, from above to below: Transverse section of male genital area during the development of the urethral channel.
Distal hypospadias: spatulated glans, ventrally cleft preputium. (Published in Scand J Plast Reconstr Surg Hand Surg 1990; 24 (1): 67-73. Reprinted with permission of the editor.)
Distal hypospadias. A traction suture is placed through the glans. Incision lines according to Scuderi repair: a coronal incision extended up to and around the meatus. (Published in Scand J Plast Reconstr Surg Hand Surg 1990; 24 (1): 67-73. Reprinted with permission of the editor.)
The dartos fascia is outlined with the terminal branches of the external pudendal arteries and veins.
Transverse section of the penis at midshaft level. From outside, the dartos fascia is visible with the blood vessels, the tunica albuginea surrounding the corpora cavernosa, and, in a ventral position, the urethra surrounded by its erectile tissue.
Distal hypospadias. Incision lines are shown.
The spatulated flap is turned over and sutured to the glans.
The urethra is reconstructed and sutured between the glanular flaps.
Preputium plasty. Reconstruction of the inner layer.
Preputium plasty. Reconstruction of the outer surface.
Normal mobility of the preputium after its reconstruction.
Artificial erection. An intracavernous injection of saline is performed while controlling the back flow at the basis of the penis with an elastic band. (Published in Scand J Plast Reconstr Surg Hand Surg 1990; 24 (1): 67-73. Reprinted with permission of the editor.)
Artificial erection achieved with normal saline injected in the corpora cavernosa while controlling the backward flow. (Published in Scand J Plast Reconstr Surg Hand Surg 1990; 24 (1): 67-73. Reprinted with permission of the editor.)
Two 5/0 traction sutures are placed on either side of the preputial apron. Outlining of the vertical preputial flap after resection of the chordee and evaluation of the urethral defect. (Published in Scand J Plast Reconstr Surg Hand Surg 1990; 24 (1): 67-73. Reprinted with permission of the editor.)
Vertical preputium flap after Scuderi repair. Note the "V" shape pattern on the inferior part of the cutaneous flap. (Published in Scand J Plast Reconstr Surg Hand Surg 1990; 24 (1): 67-73. Reprinted with permission of the editor.)
The vertical preputial flap is elevated on the dorsal cutaneous side of the penis, vertically disposed along the vascular axis (Scuderi technique), to comply with the defect to be reconstructed. The flap is mobilized with a large subcutaneous pedicle.
Elevation of the vertical preputial flap with its subcutaneous pedicle.
Buttonhole incision along the midline of the subcutaneous pedicle of the vertical preputial flap, along the axis of the blood vessel, taking care not to jeopardize the vascularization. (Published in Scand J Plast Reconstr Surg Hand Surg 1990; 24 (1): 67-73. Reprinted with permission of the editor.)
Buttonhole incision along the median line of the pedicle. (Published in Scand J Plast Reconstr Surg Hand Surg 1990; 24 (1): 67-73. Reprinted with permission of the editor.)
The flap is transposed ventrally through the buttonhole incision without tractioning or twisting the pedicle, which may impair the blood supply. Key suture between the flap and the urethra. (Published in Scand J Plast Reconstr Surg Hand Surg 1990; 24 (1): 67-73. Reprinted with permission of the editor.)
Key suture between the flap and the urethra. (Published in Scand J Plast Reconstr Surg Hand Surg 1990; 24 (1): 67-73. Reprinted with permission of the editor.)
The lower edge of the flap is sewn all around the urethral orifice.
The flap is transferred ventrally, and the lower edge of the flap is sewn all around the urethral orifice.
The flap is tubed around a urinary catheter. In this manner, the anastomosis is covered by the pedicle and the longitudinal suture lies deep between the corporeal bodies, reducing the possibility of fistula occurrence. (Published in Scand J Plast Reconstr Surg Hand Surg 1990; 24 (1): 67-73. Reprinted with permission of the editor.)
The flap is rolled into a tube. (Published in Scand J Plast Reconstr Surg Hand Surg 1990; 24 (1): 67-73. Reprinted with permission of the editor.)
The glans is split to permit the placement of the exit of the neo-meatus at the tip of the glans. A vertical strip of tissue from the ventral surface of glans is removed, and two thick triangular flaps are raised to cover the distal part of the neo-urethra. A well-closed urethra during intercourse is achieved.
Splitting of the glans. (Published in Scand J Plast Reconstr Surg Hand Surg 1990; 24 (1): 67-73. Reprinted with permission of the editor.)
Trimming of the preputium in excess.
The excess preputium is removed to provide the penis a circumcised appearance.
Final appearance at the end of the operation.
Final appearance. (Published in Scand J Plast Reconstr Surg Hand Surg 1990; 24 (1): 67-73. Reprinted with permission of the editor.)
Poor flow rate in a junctional stenosis (above). Normal flow rate (down) 1 year after dilatation. (Published in Scand J Plast Reconstr Surg Hand Surg 1990; 24 (1): 67-73. Reprinted with permission of the editor.)
Endoscopic view of the anastomosis. (Published in Scand J Plast Reconstr Surg Hand Surg 1990; 24 (1): 67-73. Reprinted with permission of the editor.)
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.