[Surgical treatment of distal hypospadias]

From a total of 1,164 cases of hypospadias operations between 1966 and 1981 we report our experience in the operative treatment of distal hypospadias (n = 208). The best time for hypospadias repair is between 3 and 6 years of life. With correction of chordee it is most important to excise all penile skin of poor quality. The standard operation for the correction of chordee is the procedure described by Erdely and Bosio. If there is insufficient penile skin, scrotal skin is used to cover the skin gap. In the case of a small scrotum, only the proximal defect is covered by scrotal skin and the distal part by the procedure described by Blair, Browne, Ombredanne and Edmunds. The formation of a new urethra is accomplished with the use of Duplay's principle. We prefer subcutaneous running suture under tension with rubber bands. In the case of multiple previous operations and failed reconstruction of the urethra a tube of scrotal skin is formed and brought to the tip of the penis subcutaneously. Many authors have described numerous procedures for the treatment of hypospadias. We have combined the advantages of all techniques and formed our own approach always taking the individual case into consideration. With this approach we have good results in the treatment of hypospadias.