FR-03 SIMON-EMMANUEL DUPLAY: THE DAWN OF HYPOSPADIOLOGY

Abstract

You have accessJournal of UrologyHistory Forum1 Apr 2018FR-03 SIMON-EMMANUEL DUPLAY: THE DAWN OF HYPOSPADIOLOGY Marc Cendron, Michael Kurtz, Erin McNamara, and David Diamond Marc CendronMarc Cendron More articles by this author , Michael KurtzMichael Kurtz More articles by this author , Erin McNamaraErin McNamara More articles by this author , and David DiamondDavid Diamond More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.3023AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Repair of the most complex forms of hypospadias was not considered until the late 19th century. Professor Duplay, a prominent French, surgeon provided the impetus for the repair of complex or proximal hypospadias by describing the malformation and its functional implications as well as reporting a new surgical technique, the fundamental principles of which are still in practice. The purpose of this study is to demonstrate his innovative approach to the evaluation and management of proximal hypospadias. METHODS Dr. Duplay published two landmark articles published in 1874 and 1880. After being translated from French to English for the first time, the articles were reviewed. We describe his new classification system as well his surgical technique and clinical experience. RESULTS Dr. Duplay details the anatomic findings of proximal hypospadias adding penoscrotal and perineal-scrotal to the existing Buisson classification. In 1874 he elucidates the functional problems that affect men with proximal hypospadias, specifically voiding dysfunction and sexual dysfunction. He then describes his technique of staged repair, which was inspired by Thiersch's repair of male epispadias. The first stage involves penile straightening. The second entails creation of a tubularized urethra and distal meatus at the tip of the glans. The third connects native urethra to the reconstructed distal segment. All procedures were under chloroform. Silver threads were used as suture material and safety pins maintained apposition. Urethral stents were used for variable lengths of time. In the 1874 report, 3 patients (2 aged 4 years and a 21 year old) underwent 4 to 6 procedures to achieve a straight penis an voiding through a meatus in the glans. In the 1880 report, 5 patients are reported "cured". Complications included hematomas, infections and partial to complete breakdown at various stages of the repair. CONCLUSIONS Given the surgical context of the late 19th century, reconstruction of the severe forms of hypospadias to create a functional urethra with a glanular urethra and a straight penis was a daunting challenge. Dr. Duplay was the first to demonstrate the feasibility of such complex repairs and thus advanced the care of patients with proximal hypospadias. His technique has since been adapted to a modern context, but the basic surgical principles that he put forth appear to have stood the test of time remarkably well. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1241-e1242 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Marc Cendron More articles by this author Michael Kurtz More articles by this author Erin McNamara More articles by this author David Diamond More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...