One-stage correction of proximal hypospadias and penoscrotal transposition

Total correction of proximal hypospadias and penoscrotal transposition (PST) is a challenge to surgeons. Staged operation is usually recommended because the blood supply to the neourethra or the skin covering the penile shaft may be severed during scrotoplasty. This paper describes results obtained using a new technique for total correction, which preserves the blood supply to the neourethra in a one-stage operation.

Between July 1998 and March 2000, five boys (mean age 4 yr) with proximal hypospadias and PST underwent total correction in a one-stage operation. The urethral meatus of these patients was located at mid shaft in one, at the penoscrotal junction in two, and at the scrotum in two. Hypospadias was repaired using the Snodgrass procedure and PST was corrected using the Ehrlich and Scardino technique. Radical bulbar urethra dissection and tunica albugineal plication were used to correct penile curvature in all five cases. The urethral stent was removed on the seventh or eighth postoperative day. The meatus was then dilated using the cone tip of an ophthalmic ointment tube two or three times per day for 2 to 4 weeks. Postoperative urinary flow was observed in the outpatient clinic.

The mean follow-up period was 11.2 months. There was no postoperative fistula. One patient had postoperative meatal stenosis that was successfully treated by dilation. Postoperatively, the penile base was well above the scrotal rhugae and the meatus was at the tip of the glans in each patient. The postoperative urinary flow was straight in all patients.

Combining Snodgrass hypospadias repair and Ehrlich and Scardino PST repair in a one-stage operation preserved the blood supply to the neourethra and achieved excellent functional and cosmetic results.