Skip to main content
SpringerLink
Log in

Hypospadias Repair: The Ongoing Challenge

  • Chapter
  • First Online:
Pediatric Urology

Abstract

Hypospadias surgery has had a continuous evolution along time. The wide spectrum of hypospadias anomalies and the many options available for hypospadias reconstruction continue to challenge the urological, pediatric surgical, and plastic surgical skills of the pediatric urologist. In the preoperative assessment, the use of hormone adjuvant therapy and the timing for surgery are analyzed. Although new information from evidence-based outcomes has made us look more critically at our decision-making process for choice of repairs, controversies in nearly every aspect of hypospadias management still exist. It is the aim of this chapter to review the areas of ongoing controversy, to provide a simple and reliable algorithm for choice of procedure that we have found useful, and to create a keener awareness about the need to base the choice of technique on intraoperative anatomical findings rather than on the preoperative location of the meatus. Finally, the need of long-term follow-up into the postadolescent years and the importance of outcomes studies from the patient’s point of view are emphasized.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Paulozzi LJ, Erickson JD, Jackson RJ (1997) Hypospadias trends in two US surveillance systems. Pediatrics 100(5):831–834

    Article  CAS  PubMed  Google Scholar 

  2. Lund L, Engebjerg MC, Pedersen L, Ehrenstein V, Nørgaard M, Sørensen HT (2009) Prevalence of hypospadias in Danish boys: a longitudinal study, 1977–2005. Eur Urol 55(5):1022–1026

    Article  PubMed  Google Scholar 

  3. Dolk H, Vrijheid M, Scott JE, Addor MC, Botting B, de Vigan C, de Walle H, Garne E, Loane M, Pierini A, Garcia-Minaur S, Physick N, Tenconi R, Wiesel A, Calzolari E, Stone D (2004) Toward the effective surveillance of hypospadias. Environ Health Perspect 112(3):398–402

    Article  PubMed Central  PubMed  Google Scholar 

  4. Elliott CS, Halpern MS, Paik J, Maldonado Y, Shortliffe LD (2011) Epidemiologic trends in penile anomalies and hypospadias in the state of California, 1985–2006. J Pediatr Urol 7(3):294–298

    Article  PubMed  Google Scholar 

  5. Fisch H, Lambert SM, Hensle TW, Hyun G (2009) Hypospadias rates in New York State are not increasing. J Urol 181(5):2291–2294

    Article  PubMed  Google Scholar 

  6. Yang Q, Qu WY, Yang L, Wang K, Tu HY, Wang J (2013) Literature on the aetiology of hypospadias in the last 5 years: molecular mechanism and environmental factors. Andrologia. doi:10.1111/and.12125

    Google Scholar 

  7. Kojima Y, Kohri K, Hayashi Y (2010) Genetic pathway of external genitalia formation and molecular etiology of hypospadias. J Pediatr Urol 6(4):346–354

    Article  PubMed  Google Scholar 

  8. Kalfa N, Sultan C, Baskin LS (2010) Hypospadias: etiology and current research. Urol Clin North Am 37(2):159–166

    Article  PubMed  Google Scholar 

  9. Kaya C, Bektic J, Radmayr C, Schwentner C, Bartsch G, Oswald J (2008) The efficacy of dihydrotestosterone transdermal gel before primary hypospadias surgery: a prospective, controlled, randomized study. J Urol 179(2):684–688

    Article  CAS  PubMed  Google Scholar 

  10. Gorduza DB, Gay CL, de Mattos E, Silva E, Demède D, Hameury F, Berthiller J, Mure PY, Mouriquand PD (2011) Does androgen stimulation prior to hypospadias surgery increase the rate of healing complications? – A preliminary report. J Pediatr Urol 7(2):158–161

    Article  PubMed  Google Scholar 

  11. Snodgrass WT, Villanueva C, Granberg C, Bush NC (2014) Objective use of testosterone reveals androgen insensitivity in patients with proximal hypospadias. J Pediatr Urol 10(1):118–122

    Article  PubMed  Google Scholar 

  12. Wright I, Cole E, Farrokhyar F, Pemberton J, Lorenzo AJ, Braga LH (2013) Effect of preoperative hormonal stimulation on postoperative complication rates after proximal hypospadias repair: a systematic review. J Urol 190(2):652–659

    Article  CAS  PubMed  Google Scholar 

  13. Berrettini A, Tringali V, Vallasciani S, Minoli DG, Manzoni G (2013) Pre-operative androgen stimulation and hypospadias complications: further informations. In: 24th Congress of the ESPU, Genoa

    Google Scholar 

  14. van der Griend BF, Lister NA, McKenzie IM, Martin N, Ragg PG, Sheppard SJ, Davidson AJ (2011) Postoperative mortality in children after 101,885 anesthetics at a tertiary pediatric hospital. Anesth Analg 112(6):1440–1447

    Article  PubMed  Google Scholar 

  15. Bush NC, DaJusta D, Snodgrass WT (2013) Glans penis width in patients with hypospadias compared to healthy controls. J Pediatr Urol 9:1188–1191

    Article  PubMed  Google Scholar 

  16. Bermudez DM, Canning DA, Liechty KW (2011) Age and pro-inflammatory cytokine production: wound-healing implications for scar-formation and the timing of genital surgery in boys. J Pediatr Urol 7(3):324–331

    Article  PubMed  Google Scholar 

  17. Schultz JR, Klykylo WM, Wacksman J (1983) Timing of elective hypospadias repair in children. Pediatrics 71(3):342–351

    CAS  PubMed  Google Scholar 

  18. American Academy of Pediatrics (1996) 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 97(4):590–594

    Google Scholar 

  19. Schönbucher VB, Landolt MA, Gobet R, Weber DM (2008) Psychosexual development of children and adolescents with hypospadias. J Sex Med 5(6):1365–1373

    Article  PubMed  Google Scholar 

  20. Weber DM, Schonbucher VB, Gobet R, Gerber A, Landolt MA (2009) Is there an ideal age for hypospadias repair? A pilot study. J Pediatr Urol 5(5):345–350

    Article  CAS  PubMed  Google Scholar 

  21. Aaronson IA (1994) Micropenis: medical and surgical implications. J Urol 152(1):4–14

    CAS  PubMed  Google Scholar 

  22. Bush NC, Holzer M, Zhang S, Snodgrass W (2013) Age does not impact risk for urethroplasty complications after tubularized incised plate repair of hypospadias in prepubertal boys. J Pediatr Urol 9(3):252–256

    Article  PubMed  Google Scholar 

  23. Perlmutter AE, Morabito R, Tarry WF (2006) Impact of patient age on distal hypospadias repair: a surgical perspective. Urology 68(3):648–651

    Article  PubMed  Google Scholar 

  24. Korvald C, Stubberud K (2008) High odds for freedom from early complications after tubularized incised-plate urethroplasty in 1-year-old versus 5-year-old boys. J Pediatr Urol 4(6):452–456

    Article  PubMed  Google Scholar 

  25. Eassa W, Jednak R, Capolicchio JP, Brzezinski A, El-Sherbiny M (2011) Risk factors for re-operation following tubularized incised plate urethroplasty: a comprehensive analysis. Urology 77(3):716–720

    Article  PubMed  Google Scholar 

  26. Kaplan GW, Lamm DL (1975) Embryogenesis of chordee. J Urol 114:769

    CAS  PubMed  Google Scholar 

  27. Kizilcan F, Tanyel FC, Cakar N, Bujukpamukcu N, Hicsonmez A (1994) The effect of intrauterine vascular compromise on further development of corpus spongiosum and urethra. Eur J Pediatr Surg 4:26–29

    Article  CAS  PubMed  Google Scholar 

  28. Hollowell JG, Keating MA, Snyder HM 3rd, Duckett JW (1990) Preservation of the urethral plate in hypospadias repair: extended applications and further experience with the Onlay island flap urethroplasty. J Urol 143(1):98–100

    CAS  PubMed  Google Scholar 

  29. Orkiszewski M, Madej J, Kilian T (2006) How wide a urethra should we produce? J Pediatr Urol 2(5):473–476

    Article  PubMed  Google Scholar 

  30. Snodgrass W (1994) Tubularized, incised plate urethroplasty for distal hypospadias. J Urol 151(2):464–465

    CAS  PubMed  Google Scholar 

  31. Dodds PR, Batter SJ, Shield DE, Serels SR, Garafalo FA, Maloney PK (2008) Adaptation of adults to uncorrected hypospadias. Urology 71(4):682–685

    Article  PubMed  Google Scholar 

  32. Fichtner J, Filipas D, Mottrie AM, Voges GE, Hohenfellner R (1995) Analysis of meatal location in 500 men: wide variation questions need for meatal advancement in all pediatric anterior hypospadias cases. J Urol 154(2 Pt 2):833–834

    CAS  PubMed  Google Scholar 

  33. Manzoni G, Bracka A, Palminteri E, Marrocco G (2004) Hypospadias surgery: when, what and by whom? BJU Int 94(8):1188–1195

    Article  PubMed  Google Scholar 

  34. Duckett JW (1981) MAGPI (meatoplasty and glanuloplasty): a procedure for subcoronal hypospadias. Urol Clin North Am 8(3):513–519

    CAS  PubMed  Google Scholar 

  35. Vallasciani S, Spagnoli A, Borsellino A, Martini L, Ferro F (2007) Simplifying the surgical approach to glanular and coronal hypospadias: longitudinal urethral incision and glanuloplasty. J Pediatr Urol 3(6):453–456

    Article  PubMed  Google Scholar 

  36. Zaontz MR (1989) The GAP (glans approximation procedure) for glanular/coronal hypospadias. J Urol 141(2):359–361

    CAS  PubMed  Google Scholar 

  37. Hayes MC, Malone PS (1999) The use of a dorsal buccal mucosal graft with urethral plate incision (Snodgrass) for hypospadias salvage. BJU Int 83(4):508–509

    Article  CAS  PubMed  Google Scholar 

  38. Elder JS, Duckett JW, Snyder HM (1987) Onlay island flap in the repair of mid and distal penile hypospadias without chordee. J Urol 138(2):376–379

    CAS  PubMed  Google Scholar 

  39. Rigamonti W, Castagnetti M (2011) Onlay on albuginea: modified onlay preputial island flap urethroplasty for single-stage repair of primary severe hypospadias requiring urethral plate division. Urology 77(6):1498–1502

    Article  PubMed  Google Scholar 

  40. Duckett JW Jr (1980) Transverse preputial island flap technique for repair of severe hypospadias. Urol Clin North Am 7(2):423–430

    PubMed  Google Scholar 

  41. Perovic S, Vukadinovic V (1994) Onlay island flap urethroplasty for severe hypospadias: a variant of the technique. J Urol 151:711–714

    CAS  PubMed  Google Scholar 

  42. Bracka A (1995) Hypospadias repair: the two-stage alternative. Br J Urol 76(Suppl 3):31–41

    Article  PubMed  Google Scholar 

  43. Snodgrass W, Bush N (2011) Tubularized incised plate proximal hypospadias repair: continued evolution and extended applications. J Pediatr Urol 7:2–9

    Article  PubMed  Google Scholar 

  44. Holland AJA, Smith GHH (2000) Effect of the depth and width of the urethral plate on tubularized incised plate urethroplasty. J Urol 164:489

    Article  CAS  PubMed  Google Scholar 

  45. Sarhan O, Saad M, Helmy T, Hafez A (2009) Effect of suturing technique and urethral plate characteristics on complication rate following hypospadias repair: a prospective randomized study. J Urol 182(2):682–685

    Article  PubMed  Google Scholar 

  46. Springer A, Krois W, Horcher E (2011) Trends in hypospadias surgery: results of a worldwide survey. Eur Urol 60(6):1184–1189

    Article  PubMed  Google Scholar 

  47. Snodgrass WT, Granberg C, Bush NC (2013) Urethral strictures following urethral plate and proximal urethral elevation during proximal TIP hypospadias repair. J Pediatr Urol 9(6 Pt B):990–994

    Article  PubMed  Google Scholar 

  48. Snodgrass W, Prieto J (2009) Straightening ventral curvature while preserving the urethral plate in proximal hypospadias repair. J Urol 182:1720–1725

    Article  PubMed  Google Scholar 

  49. Braga LH, Pippi Salle JL, Dave S, Bagli DJ, Lorenzo AJ, Khoury AE (2007) Outcome analysis of severe chordee correction using tunica vaginalis as a flap in boys with proximal hypospadias. J Urol 178(4 Pt 2):1693–1697

    Article  PubMed  Google Scholar 

  50. Leslie JA, Cain MP, Kaefer M, Meldrum KK, Misseri R, Rink RC (2008) Corporeal grafting for severe hypospadias: a single institution experience with 3 techniques. J Urol 180(4 Suppl):1749–1752

    Article  PubMed  Google Scholar 

  51. Castellan M, Gosalbez R, Devendra J, Bar-Yosef Y, Labbie A (2011) Ventral corporal body grafting for correcting severe penile curvature associated with single or two-stage hypospadias repair. J Pediatr Urol 7(3):289–293

    Article  PubMed  Google Scholar 

  52. Tuygun C, Bakirtas H, Gucuk A, Cakici H, Imamoglu A (2009) Uroflow findings in older boys with tubularized incised-plate urethroplasty. Urol Int 82(1):71–76

    Article  PubMed  Google Scholar 

  53. Andersson M, Doroszkiewicz M, Arfwidsson C, Abrahamsson K, Holmdahl G (2011) Hypospadias repair with tubularized incised plate: does the obstructive flow pattern resolve spontaneously? J Pediatr Urol 7(4):441–445

    Article  PubMed  Google Scholar 

  54. Lalla M, Riis C, Jørgensen CS, Danielsen CC, Jørgensen TM (2011) A biomechanical, histological and biochemical study in an experimental rabbit hypospadias repair model using scanning acoustic microscopy. J Pediatr Urol 7(4):404–411

    Article  PubMed  Google Scholar 

  55. Vallasciani S, Berrettini A, Manzoni G (2012) Urethral obstruction without stenosis: a cautionary tale following TIP repair. In: 23rd ESPU Meeting, Zurich

    Google Scholar 

  56. Prasad MM, Marks A, Vasquez E, Yerkes EB, Cheng EY (2012) Published surgical success rates in pediatric urology–fact or fiction? J Urol 188(4 Suppl):1643–1647

    Article  PubMed  Google Scholar 

  57. Lee OT, Durbin-Johnson B, Kurzrock EA (2013) Predictors of secondary surgery after hypospadias repair: a population based analysis of 5,000 patients. J Urol 190(1):251–255

    Article  PubMed  Google Scholar 

  58. Marrocco G, Calisti A, Materia E, Baglio G, Tancioni V (2002) The efficacy of surgical treatment of hypospadias: analysis of hospital data from Lazio region during the three year period (1996–8). Pediatr Med Chir 24(3):223–227

    CAS  PubMed  Google Scholar 

  59. Parikh AM, Park AM, Sumfest J (2014) Cumulative summation (CUSUM) charts in the monitoring of hypospadias outcomes: a tool for quality improvement initiative. J Pediatr Urol 10:306–311

    Google Scholar 

  60. Snodgrass WT, Bush N, Cost N (2010) Tubularized incised plate hypospadias repair for distal hypospadias. J Pediatr Urol 6(4):408–413

    Article  PubMed  Google Scholar 

  61. Shukla AR, Patel RP, Canning DA (2004) The 2-stage hypospadias repair. Is it a misnomer? J Urol 172(4 Pt 2):1714–1716

    Article  PubMed  Google Scholar 

  62. Cimador M, Vallasciani S, Manzoni G, Rigamonti W, De Grazia E, Castagnetti M (2013) Failed hypospadias in paediatric patients. Nat Rev Urol 10(11):657–666

    Article  PubMed  Google Scholar 

  63. Hinder UT, Duran FR, Caravaca MP (1980) In: Goldwyn RM (ed) Long term results in plastic and reconstructive surgery, 1st edn, 1. Boston Little Brown & Co, USA

    Google Scholar 

  64. Spinoit AF, Poelaert F, Groen LA, Van Laecke E, Hoebeke P (2013) Hypospadias repair at a tertiary care center: long-term follow-up is mandatory to determine the real complication rate. J Urol 189(6):2276–2281

    Article  PubMed  Google Scholar 

  65. Wood HM, Kay R, Angermeier KW, Ross JH (2008) Timing of the presentation of urethrocutaneous fistulas after hypospadias repair in pediatric patients. J Urol 180(4 Suppl):1753–1756

    Article  PubMed  Google Scholar 

  66. Nuininga JE, De Gier RP, Verschuren R, Feitz WF (2005) Long-term outcome of different types of 1-stage hypospadias repair. J Urol 174(4 Pt 2):1544–1548

    Article  PubMed  Google Scholar 

  67. Vandersteen DR, Husmann DA (1998) Late onset recurrent penile chordee after successful correction at hypospadias repair. J Urol 160(3 Pt 2):1131–1133

    Article  CAS  PubMed  Google Scholar 

  68. Rynja SP, de Jong TP, Bosch JL, de Kort LM (2011) Functional, cosmetic and psychosexual results in adult men who underwent hypospadias correction in childhood. J Pediatr Urol 7(5):504–515

    Article  CAS  PubMed  Google Scholar 

  69. Barbagli G, Perovic S, Djinovic R, Sansalone S, Lazzeri M (2010) Retrospective descriptive analysis of 1,176 patients with failed hypospadias repair. J Urol 183(1):207–211

    Article  PubMed  Google Scholar 

  70. Fraumann SA, Stephany HA, Clayton DB, Thomas JC, Pope JC 4th, Adams MC, Brock JW 3rd, Tanaka ST (2014) Long-term follow-up of children who underwent severe hypospadias repair using an online survey with validated questionnaires. J Pediatr Urol 10(3):446–450

    Article  PubMed  Google Scholar 

  71. Holland AJ, Smith GH, Ross FI, Cass DT (2011) HOSE: an objective scoring system for evaluating the results of hypospadias surgery. BJU Int 88(3):255–258

    Article  Google Scholar 

  72. Baskin L (2001) Hypospadias: a critical analysis of cosmetic outcomes using photography. BJU Int 87(6):534–539

    Article  CAS  PubMed  Google Scholar 

  73. Mureau MA, Slijper FM, Slob AK, Verhulst FC, Nijman RJ (1996) Satisfaction with penile appearance after hypospadias surgery: the patient and surgeon view. J Urol 155(2):703–706

    Article  CAS  PubMed  Google Scholar 

  74. Weber DM, Landolt MA, Gobet R, Kalisch M, Greeff NK (2013) The Penile perception score: an instrument enabling evaluation by surgeons and patient self-assessment after hypospadias repair. J Urol 189(1):189–193

    Article  PubMed  Google Scholar 

  75. Ruppen-Greeff NK, Weber DM, Gobet R, Landolt MA (2013) Health-related quality of life in men with corrected hypospadias: an explorative study. J Pediatr Urol 9(5):551–558

    Article  CAS  PubMed  Google Scholar 

  76. Chertin B, Natsheh A, Ben-Zion I, Prat D, Kocherov S, Farkas A, Shenfeld OZ (2013) Objective and subjective sexual outcomes in adult patients after hypospadias repair performed in childhood. J Urol 190(4 Suppl):1556–1560

    Article  PubMed  Google Scholar 

  77. Wei Y, Li XD, Xu N, Xue XY, Zheng QS, Jiang T, Huang JB, Sun XL (2014) Penile appearance, sexual function and sexual satisfaction of hypospadias patients after surgery: a long-term follow-up study. Zhonghua Nan Ke Xue 20(1):48–53

    PubMed  Google Scholar 

  78. Schonbucher VB, Weber DM, Landolt MA (2008) Psychosocial adjustment, health-related quality of life, and psychosexual development of boys with hypospadias: a systematic review. J Pediatr Psychol 33(5):520–535

    Article  PubMed  Google Scholar 

  79. Schonbucher V, Schweizer K, Richter-Appelt H (2010) Sexual quality of life of individuals with disorders of sex development and a 46, XY karyotype: a review of international research. J Sex Marital Ther 36(3):193–215

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pediatric Urology Unit, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Via della Commenda, 10, Milan, 20122, Italy

    Santiago Vallasciani MD, Dario G. Minoli MD & Gianantonio Manzoni FEAPU, FRCS

Authors
  1. Santiago Vallasciani MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dario G. Minoli MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gianantonio Manzoni FEAPU, FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Santiago Vallasciani MD .

Editor information

Editors and Affiliations

  1. Pediatric Surgery, S. Orsola-Malpighi University Hospital, Bologna, Bologna, Italy

    Mario Lima

  2. Pediatric Urology, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Milano, Italy

    Gianantonio Manzoni

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag Italia

About this chapter

Cite this chapter

Vallasciani, S., Minoli, D.G., Manzoni, G. (2015). Hypospadias Repair: The Ongoing Challenge. In: Lima, M., Manzoni, G. (eds) Pediatric Urology. Springer, Milano. https://doi.org/10.1007/978-88-470-5693-0_22

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-5693-0_22

  • Published:

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-5692-3

  • Online ISBN: 978-88-470-5693-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation