Hypospadias repair


Preoperative considerations

Repair tips/techniques

Postoperative management

Hypospadias complications

Penile curvature (chordee)

Penile torsion

Tubularized incision of plate (TIP) technique

  1. Can perform penile block or caudal block (some concern that caudal block increases risk for fistula formation)
  2. Position supine, prep/drape, can give cefazolin or other antibiotic due to urethral manipulation
  3. Take down preputial adhesions to assess foreskin length and location, assess degree and direction of curvature
  4. Place ethibond traction stitch into glans, place 8Fr feeding tue
  5. Perform dorsal circumcision incision, extend laterally to create Firlit wings (inner preputial wings), then extend ventraly taking care over urethra
  6. Deglove the penis, create an artificial erection to assess curvature
  7. Can perform plication stitches dorsally if necessary due to curvature (will worsen during puberty)
  8. Apply tourniquet with umbilical tape when performing glansplasty to minimize bleeding
  9. Incise urethral place at midline from glans down to meatus, use wescott scissors or small scalpel
  10. Create glans wing incisions on either side of urethra, then close with running 7-0 PDS in two layers
  11. Using excess dorsal dartos, create dartos flap (remove overlying skin), create buttonhole and place over penis so that flap lies ventrally, then secure over urethroplasty with 7-0 interrupted PDS
  12. Complete glansplasty with 5-0 PDS horizontal mattress sutures and epithelial 7-0 vicryl
  13. Exchange 8Fr feeding tube for 7Fr stent, stitch to glans to ensure it stays in place
  14. Assess and adjust skin for coverage, and place fixation stitches at penopubic and penoscrotal junctions at 12, 5, and 7 o'clock
  15. Complete circumcision, bring flaps around for adequate coverage, close with interrupted 5-0 plain gut (can perform simple or subcuticular interrupted)
  16. Apply circumferential telfa dressing, then tegaderms to hold in place
  17. Remove dressing POD#4, remove catheter POD#7, prophylactic antibiotics until POD#9