New head-mounted miniaturized microscope in hypospadia surgical correction

The aim of this paper was to report our experience using VarioscopeÒM5 in hypospadia surgical correction. To suggest the use of microsurgical principles that can result in the successful repair of hypospadias with a few complications.

Forty-three patients (age 12-16 months), affected by hypospadia, underwent longitudinal dorsal preputial island flap (Scuderi's technique) surgical procedure. All the procedures were performed with Varioscope®M5. This new device is a head-mounted miniaturized microscope which combines a microsurgical microscope illumination and magnification with the freedom of loupes.

In 39 (91.1%) of the patients the postoperative course was uneventful. One patient (2.3%) developed urethral fistula and a second intervention was necessary to correct it. He was affected by fourth degree hypospadia. In 3 patients (6.6%) we observed a mild stenosis. Urethral strictures were dilated during multiple sessions, by weekly introduction of catheters of progressively increasing caliber. At 3 months after surgery all urethral strictures had been solved by non surgical treatment, thus decreasing complication rate of the surgical procedure from 8.9% to 2.3%. Evaluation of flow rate was repeated at 3 weeks, 6 and 12 months. The aesthetic outcome was evaluated by the parents on a VAS scale. Results were judged optimal (8-9 out of 10).

In order to achieve a better aesthetic and functional outcome and to reduce complications we deem a perfect flap dissection and anastomosis necessary. A well lighted and magnified surgical field is essential to achieve the best result due to the small anatomical structures involved in the surgical technique we have adopted. The Varioscope®M5 offers essential advantages in this regard.