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Penile Hypospadias Reconstruction Workup

  • Author: Fabio Santanelli di Pompeo, MD, PhD; Chief Editor: Jorge I de la Torre, MD, FACS  more...
 
Updated: Jan 14, 2016
 

Laboratory Studies

See the list below:

  • 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.
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Imaging Studies

See the list below:

  • 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.
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Other Tests

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  • Obtain an ECG per anesthesia or operating room guidelines.
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Contributor Information and Disclosures
Author

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

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

Disclosure: Nothing to disclose.

Coauthor(s)

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

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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 Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, American Society for Reconstructive Microsurgery, Association for Academic Surgery, Medical Association of the State of Alabama

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 Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, American Society for Reconstructive Microsurgery, Association for Academic Surgery, Medical Association of the State of Alabama

Disclosure: Nothing to disclose.

Additional Contributors

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 Society for Reconstructive Microsurgery, Plastic Surgery Research Council, American Medical Association, Massachusetts Medical Society

Disclosure: Received consulting fee from Integra LifeSciences, Inc for consulting; Received consulting fee from Integra LifeSciences, Inc. for program and training services agreement; Received grant/research funds from Integra LifeSciences, Inc. for clinical research; Received grant/research funds from KCI for basic science research; Received grant/research funds from KCI for clinical research; Received consulting fee from DSM for consulting; Received consulting fee from Musculoskeletal Transplant Foundatio.

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. 1970 Apr. 45(4):365-9. [Medline].

  5. Duckett JW Jr. Transverse preputial island flap technique for repair of severe hypospadias. Urol Clin North Am. 1980 Jun. 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. Arnaud A, Ferdynus C, Harper L. Can separation of the scrotal sac in proximal hypospadias reliably predict the need for urethral plate transection?. J Pediatr Urol. 2015 Dec 17. [Medline].

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

  9. Snodgrass W, Villanueva C, Bush NC. Duration of follow-up to diagnose hypospadias urethroplasty complications. J Pediatr Urol. 2013 Dec 7. [Medline]. [Full Text].

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

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

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

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

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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.)
 
 
 
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