How I Do It

Correction of Hypospadias, Types I and II

J. C. VanderMeulen, M.D.

From the Department of Plastic and Recons tructive Surgery of the Acad. Hospital Rotterdam, Dr. Molewaterplein 40, Rotterdam, The Netherlands.

Address reprint requests to Dr. van der Meulen.

Figures 1 through 12 demonstrate the Type I proce­dure, used for hypospadias without chordee. Figures 13 through 28 demonstrate Stage 1 of the Type II procedure, used for hypospadias with chordee, while figures 29 through 31 show Stage 2.

Fig 1. Type I procedme. Ventral view.

Fig 2. Lateral view.

403 0148-7043/82/050403-09$01.25 © 198 1 by Little, Brown and Company (Inc.)

Annals of Plastic Surgery Vol 8 No 5 May 1982

Fig 3. Marking the urethral strip and two triangles on each side of the navicular fossa.

Fig 4. Marking the incision on the dorsal aspect at the level of the corona (dashed line represents site of possible back cut).

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Fig 5. Using the bipolar cutting diathermy, the ventral skin over the urethra is mobilized, taking care not to perforate the urethra itself.

Fig 6. The urethral strip is outlined. The glandular trian­gles on each side of the navicular fossa have been re­moved.

How I Do It: Van der Meulen: Correction of Hypospadias

Fig 7. Mobilization and presentation of dorsal skin flap. if necessary, a back cut is made to facilitate rotation (see Fig 4).

Fig 8. Rotation of flap to ventral side of the penis.

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Fig 9. The transposition flap is rotated over the urethral strip and fixed to the raw areas on each side of the ure­thral strip with one or two rows of interrupted subcuta­neous sutures.

Fig 10. The edge of the V-shaped defect, which is pro­duced in the dorsal skin after rotation of the transposi­tion flap, is sutured to the corona or to skin that is left at· tached to it.

Annals of Plastic Surgery Vol 8 No 5 May 1982

Fig 11. Ventral view of penis several months postopera­tively.

Fig 12. The meatus is situated at or near the tip of the glans.

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Fig 13. Type II procedure, Stage 1. Ventral view.

Fig 14. Lateral view.

How I Do It: Van der Meulen: Correction of Hypospadias

Fig 15. Dissection of dorsal hood by means of an incision at corona made by a bipolar cutting diathermy.

Fig 16. Completing dissection of dorsal hood.

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Fig 17. Starting dissection of the cavernosal corpus through an incision distal to the meatus. During the course of the dissection, which is performed with delicate transverse strol<es of the cutting diathermy, the corpora are held under tension by thumb and index finger of the supporting hand. Care is taken not to enter the corpora.

Fig 18. Ventral view after release. Small holes in the cor­pora must be sutured to stop the bleeding.

Annals of Plastic Surgery Vol 8 No 5 May 1982

Fig 19. Dorsal view after release.

Fig 20. Lateral view after release.

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Fig 21. A back cut is made along the course of the oblique raphe.

Fig 22. The back cut allows for easy transposition of the released prepuce to the ventral side of the penis.

How I Do It: Van der Meulen: Correction of Hypospadias

Fig 23. The circulation of the prepuce supplied by an axial artery is left intact.

Fig 24. The navicul ar fossa is split with the cutting dia­thermy so that it will harbor the inner lining of the pre­puce.

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Fig 25. After transposition of the prepuce to the lateral aspect of the penis, and splitting of the glans.

Fig 26. After closure of the dorsal aspect. The deepest poin t of the back cut is sutured to the corona in the mid­line.

Annals of Plastic Surgery Vol 8 No 5 May 1982

Fig 27. The defect on the ventral side is easily closed with the inner lining of the prepuce, avoiding transverse scar8 in the immediate vicinity of the meatus.

Fig 28. The inner lining of the prepuce is anchored to the deepest point of the glandular defect and held in situ with a bolus. Interrupted subcutaneous sutures are used throughout the procedure.

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Fig 29. Stage 2. Surplus of skin on lateral aspect is pre­sented. The urethral strip is outlined.

Fig 30. Formation of urethral strip after careful inspection of the meatus. The transposition of urethra to urethral strip should be as smooth as possible, to avoid strictures.

How I Do It: Van der Meulen: Correction of Hypospadias

Fig31. The surplus of skin is mobilized and anchored to the contralateral side of the penis with a double row of interrupted subcutaneous sutures. Two drainage inci­sions are made at a safe distance on each side of the penile base; a silicone drain is passed through the inci­sion. No catheters are used.

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