Augmented Duckett repair for severe hypospadias

In severe cases of hypospadias the meatus, either before or after release of the chordee, may lie in a position that is so proximal that there may not be enough inner foreskin available for an island pedicle tube to bridge the long gap between the meatus and the tip of the glans. In such cases a proximal add-on neourethra can be fashioned from nonhair-bearing interscrotal tissue or ventral penile skin overlying the fibrous chordee-causing tissue. The end result is a Duckett transverse preputial tube that is anastomosed proximally to a Thiersch-Duplay neourethra and distally to the tip of the glans. This procedure allows the surgeon to bridge large gaps with a 1-stage repair and avoids the necessity of a free graft.