Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-669899f699-g7b4s Total loading time: 0 Render date: 2025-05-02T07:53:26.506Z Has data issue: false hasContentIssue false

47 - Hypospadias

from Part V - Urology

Published online by Cambridge University Press:  08 January 2010

By
Laurence S. Baskin
Edited by
Mark D. Stringer ,
Keith T. Oldham  and
Pierre D. E. Mouriquand
Laurence S. Baskin
Affiliation:
Department of Urology, UCSF Children's Medical Center, University of California, San Francisco, USA
Mark D. Stringer
Affiliation:
University of Otago, New Zealand
Keith T. Oldham
Affiliation:
Children's Hospital of Wisconsin
Pierre D. E. Mouriquand
Affiliation:
Debrousse Hospital, Lyon
Get access

Summary

Introduction

The treatment of hypospadias has a long and colorful history dating back to AD 100–200, when Heliodorand Antyl is credited with the first surgical management. Since that time, the study of hypospadias has evolved into a subspecialty within pediatric urology, hypospadiology.

In Western civilization the incidence of hypospadias is reported to be increasing. A leading hypothesis which is under investigation is maternal exposure to environmental pollutants or endocrine disruptors.

Modern techniques have evolved from the myriad of operations described by the pioneers of hypospadias surgery. An understanding of these techniques is germane to present-day practice. We have now come full circle to accept the multistep operations for severe hypospadias and redo surgery which historically had been the procedure of choice. It is no longer taboo to consider a two-stage approach as opposed to repairing all hypospadias with a single operation.

Historically, the first stage of hypospadias surgery consisted of penile straightening. This was followed by a second-stage urethroplasty using various techniques such as ventral skin tubes (Thiersch-Duplay, flip flaps, Mathieu, Ombredanne and Beck) or urethral mobilization (Beck–Hacker). Alternatively, Dennis Browne buried a strip of epithelium for subsequent tubularization. Blair and Byars championed the vertical split of the dorsal hood rotated to the ventrum and advanced onto a split glans for subsequent tubularization. This was the most popular repair and is similar to the two-stage approach advocated today.

Type
Chapter
Information
Pediatric Surgery and Urology
Long-Term Outcomes
 , pp. 611 - 620
Publisher: Cambridge University Press
Print publication year: 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Paulozzi, L., Erickson, D., & Jackson, R.Hypospadias trends in two US surveillance systems. Pediatrics 1997; 100:831–834.CrossRefGoogle ScholarPubMed
Paulozzi, L. J.International trends in rates of hypospadias and cryptorchidism. Environ, Health Perspect, 1999; 107:297–302.CrossRefGoogle ScholarPubMed
Baskin, L. S., Colborn, T., & Himes, K.Hypospadias and endocrine disruption: is there a connection?Environm. Health Perspect. 2001; 109:1175–1183.CrossRefGoogle Scholar
North, K. & Golding, J.A maternal vegetarian diet in pregnancy is associated with hypospadias. The ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood. BJU Int. 2000; 85:107–113.Google ScholarPubMed
Greenfield, S. P.Two-stage repair for proximal hypospadias: a reappraisal. Curr. Urol. Rep. 2003; 4:151–155.CrossRefGoogle ScholarPubMed
Greenfield, S. P., Sadler, B. T., & Wan, J.Two-stage repair for severe hypospadias. J. Urol. 1994; 152:498–501.CrossRefGoogle ScholarPubMed
Bracka, A.A long-term view of hypospadias. Br. J. Plast. Surg. 1989; 42:251–255.CrossRefGoogle ScholarPubMed
Titley, O. G. & Bracka, A.A 5-year audit of trainees experience and outcomes with two-stage hypospadias surgery. Br. J. Plast. Surg. 1998; 51:370–375.CrossRefGoogle ScholarPubMed
Bracka, A.Hypospadias repair: the two-stage alternative. Br. J. Urol. 1995; 76Suppl 3:31–41.CrossRefGoogle ScholarPubMed
Duckett, J.Transverse preputial island flap technique for repair of severe hypospadias. Urol. Clin. North Am. 1980; 7:423–431.Google ScholarPubMed
Duckett, J. W.The current hype in hypospadiology. Br. J. Urol. 1995; 76Suppl 3:1–7.CrossRefGoogle ScholarPubMed
Thiersch, C.Ueber die Entstehungsweise und operative Behandlung der epispadie. Arch. Heitkunde 1869; 10:20.Google Scholar
Mathieu, P.Traitement en un temps de l'hypospadias balanique et juxtablalanique. J. Chir. 1932; 39:481.Google Scholar
Ombredanne, L.Precis Clinique et Operation de Chirurgie InfantileParis: Masson, 1932.Google Scholar
Beck, C.Hypospadias and its treatment. Surg. Gynecol. Obstet. 1917; 24:511–532.Google Scholar
Browne, D.An operation for hypospadias. Lancet 1936; 1:141.CrossRefGoogle Scholar
Byars, L.Technique of consistently satisfactory repair of hypospadias. Surg. Gynecol. Obstet. 1955; 100:184–190.Google ScholarPubMed
Retik, A. B., Bauer, S. B., Mandell, J., Peters, C. A., Colodny, A., & Atala, A.Management of severe hypospadias with a two-stage repair. J. Urol. 1994; 152:749–51.CrossRefGoogle Scholar
Devine, C Jr. & Horton, C.A one-stage hypospadias repair. J. Urol. 1961; 85:166–172.CrossRefGoogle ScholarPubMed
Salmon, M.Arteries de la peau. Paris: Masson, 1936; 174–179.Google Scholar
Hodgson, N.A one-stage hypospadias repair. J. Urol. 1970; 104:281–284.CrossRefGoogle ScholarPubMed
Asopa, H., Elhence, I., Atria, S., & Bansal, N.One-stage correction of penile hypospadias using a foreskin tube. A preliminary report. Int. Surg. 1971; 55:435–440.Google ScholarPubMed
Standoli, L.One-stage repair of hypospadias: preputial island flap technique. Ann. Plast. Surg. 1982; 9:81–88.CrossRefGoogle ScholarPubMed
Gittes, R. & McLaughlin, A. I.Injection technique to induce penile erection. Urology 1974; 4:473–475.CrossRefGoogle ScholarPubMed
Baskin, L. S., Erol, A., Li, Y. W., & Cunha, G. R.Anatomical studies of hypospadias. J. Urol. 1998; 160:1108–1015.CrossRefGoogle ScholarPubMed
Baskin, L. S., Erol, A., Li, Y. W., & Liu, W.Anatomy of the neurovascular bundle: is safe mobilization possible?J. Urol. 2000; 164:997–980.CrossRefGoogle ScholarPubMed
Yucel, S. & Baskin, L. S.Identification of communicating branches among the dorsal, perineal and cavernous nerves of the penis. J. Urol. 2003; 170:153–158.CrossRefGoogle ScholarPubMed
Erol, A., Baskin, L. S., Li, Y. W., & Liu, W. H.Anatomical studies of the urethral plate: why preservation of the urethral plate is important in hypospadias repair. BJU Int. 2000; 85:728–734.CrossRefGoogle ScholarPubMed
Baskin, L. S., Duckett, J. W., Ueoka, K., Seibold, J., & Snyder, H. D.Changing concepts of hypospadias curvature lead to more onlay island flap procedures. J. Urol. 1994; 151:191–196.CrossRefGoogle ScholarPubMed
Snodgrass, W.Tubularized, incised plate urethroplasty for distal hypospadias. J. Urol. 1994; 151:464–465.CrossRefGoogle ScholarPubMed
Snodgrass, W., Koyle, M., Manzoni, G., Hurwitz, R., Caldamone, A., & Ehrlich, R.Tubularized incised plate hypospadias repair for proximal hypospadias. J. Urol. 1998; 159:2129–2131.CrossRefGoogle ScholarPubMed
American Academy of Pediatrics. Timing of elective surgery on the genitalia of male children with particular reference to the risks, benefits, and psychological effects of surgery and anesthesia. Pediatrics 1996; 97:590–594.
Baskin, L. S.Hypospadias: a critical analysis of cosmetic outcomes using photography. Br. J. Urol. Int. 2001; 87:534–539.CrossRefGoogle ScholarPubMed
Retik, A. B., Keating, M., & Mandell, J.Complications of hypospadias repair. Urol. Clin. North Am. 1988; 15:223–236.Google ScholarPubMed
Hayashi, Y., Mogami, M., Kojima, Y.et al.Results of closure of urethrocutaneous fistulas after hypospadias repair. Int. J. Urol. 1998; 5:167–169.CrossRefGoogle ScholarPubMed
Emir, L. & Erol, D.Mathieu urethroplasty as a salvage procedure: 20-year experience. J. Urol. 2003; 169:2325–2326; author reply 2326–2327.CrossRefGoogle ScholarPubMed
Scherz, H. C., Kaplan, G. W., Packer, M. G., & Brock, W. A.Post-hypospadias repair urethral strictures: a review of 30 cases. J. Urol. 1988; 140:1253–1255.CrossRefGoogle ScholarPubMed
Hsiao, K. C., Baez-Trinidad, L., Lendvay, T.et al.Direct vision internal urethrotomy for the treatment of pediatric urethral strictures: analysis of 50 patients. J. Urol. 2003; 170:952–955.CrossRefGoogle ScholarPubMed
Jayanthi, V. R.The modified Snodgrass hypospadias repair: reducing the risk of fistula and meatal stenosis. J. Urol. 2003; 170:1603–1605; discussion 1605.CrossRefGoogle ScholarPubMed
Cheng, E. Y., Vemulapalli, S. N., Kropp, B. P.et al.Snodgrass hypospadias repair with vascularized dartos flap: the perfect repair for virgin cases of hypospadias?J. Urol. 2002; 168:1723–1726; discussion 1726.CrossRefGoogle ScholarPubMed
Barbagli, G., Palminteri, E., Bracka, A., & Caparros Sariol, J.Penile urethral reconstruction: concepts and concerns. Arch. Esp. Urol. 2003; 56:549–556.Google ScholarPubMed
Fichtner, J., Filipas, D., Mottrie, A. M., Voges, G. E., & Hohenfellner, R.Analysis of meatal location in 500 men: wide variation questions need for meatal advancement in all pediatric anterior hypospadias cases. J. Urol. 1995; 154:833–834.CrossRefGoogle ScholarPubMed
Genc, A., Taneli, C., Oksel, F., Balkan, C., & Bilgi, Y.Analysis of meatal location in 300 boys. Int. Urol. Nephrol. 2001; 33:663–664.CrossRefGoogle ScholarPubMed
Secrest, C. L., Jordan, G. H., Winslow, B. H.et al.Repair of the complications of hypospadias surgery. J. Urol. 1993; 150:1415–1418.CrossRefGoogle ScholarPubMed
Bracka, A.A versatile two-stage hypospadias repair. Br. J. Plast. Surg. 1995; 48:345–352.CrossRefGoogle ScholarPubMed
Baskin, L. S. & Duckett, J. W.Buccal mucosa grafts in hypospadias surgery. Br. J. Urol. 1995; 76Suppl 3:23–30.CrossRefGoogle ScholarPubMed
Mingin, G. & Baskin, L. S.Management of chordee in children and young adults. Urol. Clin. North Am. 2002; 29:277–284, v.CrossRefGoogle ScholarPubMed
Baskin, L., Duckett, J., & Lue, T.Penile curvature. Urology 1996; 48:347–356.CrossRefGoogle ScholarPubMed
Devine, C Jr. & Horton, C.Use of dermal graft to correct chordee. J. Urol. 1975; 113:56–58.CrossRefGoogle ScholarPubMed
Angermeier, K. W., Jordan, G. H., & Schlossberg, S. M.Complex urethral reconstruction. Urol. Clin. North Am. 1994; 21:567–581.Google ScholarPubMed
Keating, M. A., Cartwright, P. C., & Duckett, J. W.Bladder mucosa in urethral reconstructions. J. Urol. 1990; 144:827–834.CrossRefGoogle ScholarPubMed
Hendren, W. H. & Keating, M. A.Use of dermal graft and free urethral graft in penile reconstruction. J. Urol. 1988; 140:1265–1269.CrossRefGoogle ScholarPubMed
Duckett, J., Coplen, D., Ewalt, D., & Baskin, L.Buccal mucosa in urethral reconstruction. J. Urol 1995; 153:1660–1663.CrossRefGoogle Scholar
Johanson, B. & Avellan, L.Hypospadias. A review of 299 cases operated 1957–69. Scand. J. Plast. Reconstr. Surg. 1980; 14:259–267.CrossRefGoogle ScholarPubMed
Farkas, L. G. & Hynie, J.After effects of hypospadias repair in childhood. Postgrad. Med. 1970; 47:103–105.CrossRefGoogle Scholar
Kenawi, M.Sexual function in hypospadias. Br. J. Urol. 1975; 47:883–890.CrossRefGoogle Scholar
Sommerlad, B. C.A long-term follow-up of hypospadias patients. Br. J. Plast. Surg. 1975; 28:324–330.CrossRefGoogle ScholarPubMed
Svensson, J. & Berg, R.Micturition studies and sexual function in operated hypospadiacs. Br. J. Urol. 1983; 55:422–426.CrossRefGoogle ScholarPubMed
Bracka, A.Sexuality after hypospadias repair. BJU Int. 1999; 83 Suppl 3:29–33.CrossRefGoogle ScholarPubMed
Eberle, J., Uberreiter, S., Radmayr, C., Janetschek, G., Marberger, H., & Bartsch, G.Posterior hypospadias: long-term followup after reconstructive surgery in the male direction. J. Urol. 1993; 150:1474–1477.CrossRefGoogle ScholarPubMed
Gearhart, J. P., Linhard, H. R., Berkovitz, G. D., Jeffs, R. D., & Brown, T. R.Androgen receptor levels and 5 alpha-reductase activities in preputial skin and chordee tissue of boys with isolated hypospadias. J. Urol. 1988; 140:1243–1246.CrossRefGoogle ScholarPubMed
Klocker, H., Kaspar, F., Eberle, J., Uberreiter, S., Radmayr, C., & Bartsch, G.Point mutation in the DNA binding domain of the androgen receptor in two families with Reifenstein syndrome. Am. J. Hum. Genet. 1992; 50:1318–1327.Google ScholarPubMed
Albers, N., Ulrichs, C., Gluer, S.et al.Etiologic classification of severe hypospadias: implications for prognosis and management [see comments]. J. Pediatr. 1997; 131:386–392.CrossRefGoogle Scholar
Snodgrass, W., Koyle, M., Manzoni, G., Hurwitz, R., Caldamone, A., & Ehrlich, R.Tubularized incised plate hypospadias repair: results of a multicenter experience. J. Urol. 1996; 156:839–841.CrossRefGoogle ScholarPubMed
Hammouda, H. M., El-Ghoneimi, A., Bagli, D. J., McLorie, G. A., & Khoury, A. E.Tubularized incised plate repair: functional outcome after intermediate followup. J. Urol. 2003; 169:331–333; discussion 333.CrossRefGoogle ScholarPubMed
Jayanthi, V. R., McLorie, G. A., Khoury, A. E., & Churchill, B. M.Functional characteristics of the reconstructed neourethra after island flap urethroplasty [see comments]. J. Urol. 1995; 153:1657–1659.CrossRefGoogle Scholar
Garibay, J. T., Reid, C., & Gonzalez, R.Functional evaluation of the results of hypospadias surgery with uroflowmetry. J. Urol. 1995; 154:835–836.CrossRefGoogle ScholarPubMed
Elbakry, A.Complications of the preputial island flap-tube urethroplasty. BJU Int. 1999; 84:89–94.CrossRefGoogle ScholarPubMed
Werff, J. F., Boeve, E., Brusse, C. A., & Meulen, J. C.Urodynamic evaluation of hypospadias repair. J. Urol. 1997; 157:1344–1346.CrossRefGoogle ScholarPubMed
Werff, J. F. & Ultee, J.Long-term follow-up of hypospadias repair. Br. J. Plast. Surg. 2000; 53:588–592.CrossRefGoogle ScholarPubMed
MacMillan, R. D., Churchill, B. M., & Gilmour, R. F.Assessment of urinary stream after repair of anterior hypospadias by meatoplasty and glanuloplasty. J. Urol. 1985; 134:100–102.CrossRefGoogle ScholarPubMed
Park, J. M., Faerber, G. J., & Bloom, D. A.Long-term outcome evaluation of patients undergoing the meatal advancement and glanuloplasty procedure [see comments]. J. Urol. 1995; 153:1655–1656.CrossRefGoogle Scholar
Amukele, S. A., Lee, G. W., Stock, J. A., & Hanna, M. K.20-year experience with iatrogenic penile injury. J. Urol. 2003; 170:1691–1694.CrossRefGoogle ScholarPubMed
Hensle, T. W., Tennenbaum, S. Y., Reiley, E. A., & Pollard, J.Hypospadias repair in adults: adventures and misadventures. J. Urol. 2001; 165:77–79.CrossRefGoogle ScholarPubMed
Hensle, T. W., Kearney, M. C., & Bingham, J. B.Buccal mucosa grafts for hypospadias surgery: long-term results. J. Urol. 2002; 168:1734–1736; discussion 1736–1737.CrossRefGoogle ScholarPubMed
MacKinnon, A. E.Upper renal tract anomalies in patients with hypospadias [letter]. J. Pediatr. Surg. 1990; 25:1309.CrossRefGoogle Scholar
Mureau, M. A., Slijper, F. M., Slob, A. K., Verhulst, F. C., & Nijman, R. J.Satisfaction with penile appearance after hypospadias surgery: the patient and surgeon view. J. Urol. 1996; 155:703–706.CrossRefGoogle Scholar
Mureau, M. A., Slijper, F. M., Nijman, R. J., Meulen, J. C., Verhulst, F. C., & Slob, A. K.Psychosexual adjustment of children and adolescents after different types of hypospadias surgery: a norm-related study. J. Urol. 1995; 154:1902–1907.CrossRefGoogle ScholarPubMed
Mureau, M. A., Slijper, F. M., Meulen, J. C., Verhulst, F. C., & Slob, A. K.Psychosexual adjustment of men who underwent hypospadias repair: a norm-related study. J. Urol. 1995; 154:1351–1355.CrossRefGoogle ScholarPubMed
Mondaini, N., Ponchietti, R., Bonafe, M.et al.Hypospadias: incidence and effects on psychosexual development as evaluated with the Minnesota Multiphasic Personality Inventory test in a sample of 11,649 young Italian men. Urol. Int. 2002; 68:81–5.CrossRefGoogle Scholar
Migeon, C. J., Wisniewski, A. B., Gearhart, J. P.et al.Ambiguous genitalia with perineoscrotal hypospadias in 46,XY individuals: long-term medical, surgical, and psychosexual outcome. Pediatrics 2002; 110:e31.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×