Etiologic Considerations in Penoscrotal Hypospadias Repair

Abstract

Superficial location of fivrous bands causing chordee in patients with penoscrotal hypospadias has been demonstrated by microscopic and gross photographs. Our technique to manage this problem is similar to that described by Allen and Spence and by King for distal hypospadias and has been used in 120 patients. The technique involves the repair of the embryologic penile defect by advancing the closure of the urethral groove and transposing the scrotum to its appropriate caudal position. The repair is applicable in patients with failure of fusion rather than failure of the development of the urethral groove as in perineal hypospadias.

One-Stage Repair of Hypospadias – Experience with 856 Cases

“…Artificial erection is necessary in order to evaluate the severity of this curvature. In most cases, dartos mobilization with preservation of the urethral plate is adequate [7], but in severe cases mobilization of the urethral meatus and Nesbit procedure or dorsal plication of the tunica albuginea is required [8]. In these cases the new location of the urethral meatus and the absence of the urethral plate could change the type of hypospadias, but one-stage repair is still possible by tubularizing the pedicled island flap [9, 10].…”

One-Stage Repair of Perineal Hypospadias and Scrotal Transposition

“…In the pre vious report the distal urethral tip was not detached from the glans, but instead left tenuously attached to it during a rather extensive urethral mobilization. This was based on the rationale that in distal to penoscrotal hypospadias the urethra itself does not contribute to chordee deformity once shaft 'degloving' was accomplished by dartos mobi lization [4]. Proximal to penoscrotal hypospadias, as in the present case, the urethra must be severed and de tached from the glans because it is often atretic and by itself contributes significantly to the formation of chordee deformity [5].…”

Posterior Hypospadias Repair: A New Technical Approach

“…The latter is due to fibrous bands which replace the subcutaneous areolar tissue be tween the skin and Buck's fascia. This fascia is well devel oped in the corpora cavernosa but often rudimentary in the corpus spongosium and the subcutaneous slope of the urethra [13]. These fibrous bands are denser close to the attachment of the ectopic urethral meatus to the scrotum [12,14], The corpus spongium itself, deficient on the ven tral face of the urethra but spreading laterally, is not fibrous.…”