Hypospadias Repair: Surgical Management and Post Operative Assessment

Abstract

Preoperative evaluation is an integral part of hypospadias surgery. It includes the type of hypospadias, size of urethral plate and glans, chordee and penile torque, hypoplastic urethral length and dorsal hood. Severe hypospadias should be evaluated radiologically for lower and upper urinary tract, hormonal status, and intersex disorders. Six to 18 months of age is the golden time to operate the hypospadias patients. Patients are operated on under general anaesthesia, regional and local blocks for postoperative pain. The microsurgical instruments, magnification, and gentle tissue handling help to have better results. Bladder drainage with an appropriate catheter helps in improving the outcomes. The use of local or systemic hormones is useful for improving the growth and vascularity of the urethral plate in the patients with poorly developed urethral plate. The urethral plate preservation urethroplasty results are better, and the addition of spongioplasty to TIPU reconstructs a near-normal urethra. The algorithms are proposed with a rational approach for both one- and two-stage urethroplasty. Surgical training, experience, and type of hypospadias guide the surgeon to choose one-stage or two-stage repair. Applying the basic microsurgical principles, choice of one- or two-stage in a given case, use of the magnification and fine suture material, surgery at desired age, and proper postoperative care yield good results of hypospadias repair.