Abstract
Introduction: Hypospadias is a complex congenital deformity which requires meticulous surgical technique. Several techniques have been advocated during the past 150 years to address chordee and construction of neourethra. This study highlights the surgical techniques and experience with primary hypospadias cases. Materials and Methods: A total of 65 patients aged ranges from 1 to 18 years underwent primary hypospadias repair at our center from August 2007 to December 2012. Exclusion criteria - previous surgical attempt or with incomplete follow-up. Patients with inadequate phallic size and age <12 years were administered injection testosterone (Testoviron) prior to the surgery. Patients with significant chordee underwent chordee correction followed by urethral reconstruction by either tubularized incised plate (TIP) or on-lay flap repair/dartos flap repair. In all the patients, infant feeding tube was kept per urethrally for 3 weeks and was removed between the post-operative day 18 th and 21 st day. Results: Out of 65 patients, 24 patients underwent TIP. A total of 41 patients underwent on-lay flap repair; of this six patients of midscrotal/perineal hypospadias underwent a combination of paraurethral skin and on-lay flap repair. Chordee correction was done in all the five cases of chordee without hypospadias (congenital short urethra) and dysplastic, transparent urethra repaired with on-lay flap repair. In our study, complications like flap necrosis and fistula were seen in 10 cases and other minor complications like superficial epidermal sloughing were seen in 13 cases which healed with epithelialization. Meatal stenosis was more commonly observed with TIP (four cases) and in two cases of on-lay repair. Conclusion: Historically, hypospadias surgery was regarded as non-rewarding surgical reconstruction due to higher complication and failure rates. For hypospadias, if planned properly, primary single stage repair; acceptable surgical success is an achievable target.
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