[Treatment of hypospadias]

The aim of surgery for hypospadias is to reconstruct in one stage, at about 2 years of age, a penis that will be functionally and cosmetically, as close to normal as possible. We described the various techniques that we use depending on the degree of meatal ectopia and the presence or absence of chordee. We have treated hypospadia that is strictly glandular either with Duckett's Magpi procedure (54 cases, 49 long-term follow-up, 47 good results, retraction of the meatus in two), or Koff's advancement procedure if there is a grow in glans (13 cases, 12 good results, on requiring meatostomy). Although these meatoplasties do give good results, they hide the malformation rather than correct it and must therefore be reserved for those forms that are strictly glandular. We have treated coronal and distal shaft hypospadias without chordee by the technique of Mathieu combined with the Byars method of coverage (50 cases, 4 fistulae successfully corrected at a second one-day surgery, no stenosis--only one poor cosmetic result. In all other form of hypospadias one must first correct the chordee. The incision and the correction of the various elements that contribute to the chordee are described in detail. After straightening if the meatus is distal to the mid-point of the phallus the Devine-Horton "flip-flap" procedure is used (240 cases, 17 fistulae, (17%), 10 meatal stenosis (4%), 95 excellent cosmetic result). If, after straightening, the meatal opening is proximal to the phallus grafting is necessary.(ABSTRACT TRUNCATED AT 250 WORDS)