Hypospadias--a review of long-term use of pull-through sutures

This work covers an experience of 174 patients operated for hypospadias over twelve and a half years (1962 through August, 1974). The series includes 22 adolescents and adults whose special needs were taken into account. The outstanding feature has been a notably low fistula and breakdown rate of approximately 5%. The buried skin strip principle was utilized. The importance of early, watertight union of the subcutaneous tissues of the lateral flaps is emphasized, as it has been observed that epithelialization of the neourethra is completed only in the fourth postoperative week. This means that the urinary stream has to pass over raw but firmly united subcutaneous tissue opposite the buried skin strip for at least two weeks after discontinuation of urinary diversion. The integrity of skin closure is equally important, since local necrosis leads to separation of subcutaneous tissues and to fistula formation. Pull-through sutures of monofilament nylon were introduced by the author in 1962 for this purpose. A long-term review describing the usefulness of this method is presented.