Hypospadias Repair

Hypospadias represents the most common congenital anomaly identifiable in a newborn. Hypospadias results from abnormal development of the penile shaft, manifested by a urethral meatus proximal to its normal glandular position at any point along the penis, scrotum, or perineum and accompanied by a spectrum of abnormalities, including ventral curvature of the penis (chordee). The abnormal meatal opening can occur anywhere along the penis or in the perineum. However, the more proximal the meatus is located, the likelihood of curvature increases. 

It presents variable degrees, classified from the mildest (anterior hypospadias), intermediate (middle hypospadias), to the most severe (posterior hypospadias). Anterior hypospadias is more frequent. They represent varying degrees of virilization of the external genitalia in the male sex and varying degrees of virilization of the female genitalia. Due to the complex regulation of sexual development during fetal life, the presence of hypospadias may be a consequence of failure in one or more of the stages of sexual development. The more severe the hypospadias and even more so if accompanied by other signs and symptoms, the more likely it will be possible to detect the cause of the hypospadias.

The diagnostic itinerary requires the establishment of an excellent clinical history with family and personal history, the realization of a karyotype, an abdominal ultrasound to detect the presence of female internal genitalia, palpation of gonads, urgent determination of serum 17-OH-P when the gonads are not palpable to rule out or diagnose congenital adrenal hyperplasia in a 46.XX girl, and finally, hormonal decisions of testosterone, possible precursors and dihydrotestosterone, antimüllerian hormone, and LH and FSH gonadotrophins when the karyotype is not 46.XX. 

There are many surgical procedures described for the correction of hypospadias in different degrees and very variable reports on the complication rates derived from these procedures. Therefore, it is interesting to identify the most used technique according to the type of hypospadias, cosmetic and functional results.

The ideal treatment involves surgery; the perfect age for genital surgery is between six to 12 months. Unfortunately, there is no single, universal hypospadias repair technique; several well-established methods are available to repair all hypospadias defects that may occur. Hypospadias surgery aims to obtain a functional sexual organ free of curvature; it is equally essential to achieve a glandular urethral meatus with a laminar flow and aesthetic success.

It is necessary to reconstruct the missing piece of the urethra up to the tip of the penis. Unfortunately, there are no synthetic materials to complete the duct, so it must be done with tissue from the body itself, from the penis itself, from the skin of the foreskin, or even from the lower lip. The penis must also be straightened, correcting this downward curve. And finally, a solution must be given to the skin of the foreskin that is open, either by removing it or reconstructing it so that it looks like a cylinder again. There is no single surgical technique to treat hypospadias: it is not the same to reconstruct a few millimeters of the urethra to reconstruct the entire urethra of the penis. Therefore, it is necessary to indicate for each child the type of surgery he needs. And it is not unusual for the surgeon not to know what superior technique is required until the curvature of the penis is corrected in the operating room, and he can calculate the definitive centimeters of the urethra that are missing. So, every surgeon who treats these children must know the different techniques to provide a solution to any hypospadias.