The history of hypospadias

Abstract

The dictum, "There is nothing new in surgery not previously described", is particularly true of hypospadias. The major significance of chordee was fully appreciated by Galen in the second century A. D. and then almost forgotten until Mettauer in 1842, all previous surgeons overstressing the position of the orifice. Mettauer recognised skin shortening as a cause of chordee, a fact not re-discovered until 1967. Urethroplasty from penile skin in situ was well described by Thiersch in 1869 and Duplay in 1874; additional covering skin flaps were developed in 1892 by Lauenstein. The modern enthusiasm for pedicle tubes from prepuce was first employed by Van Hook in 1896, Rochet in 1899, Hamilton Russell in 1900, and Mayo in 1901; the "buried skin" technique of Denis Browne was described by Duplay in 1880, although attributed by Browne to Hamilton Russell in 1915. Even scrotal tissues were incorporated in repairs in 1860 (Bouisson). Beck, in 1898, practised a repair for balanitic hypospadias very similar to the modern MAGPI repair, and free grafts, so popularised in the last 20 years, were performed by Nove-Josserand in 1897. We have certainly advanced from the era of the first millenium A. D., in which the treatment was amputation beyond the orifice, but almost all present-day techniques are well-founded in ideas developed by enterprising surgeons of the last century.