A new approach in hypospadias repair

The field of hypospadiology remains full of challenges in the search for new and better solutions. In recent years, our concept has involved being very radical in penile reconstructive surgery, using an aggressive approach. The penile disassembly technique, either complete or incomplete, is used successfully in epispadias repair. We began using penile disassembly in hypospadias repair in November 1995. The technique was applied on 112 patients aged from 9 months to 32 years. Indications were: hypospadias with severe penile curvature (especially when the curvature was located in the distal third of the corpora cavernosa), chordee without hypospadias, and small penises with hypospadias. The principle of the technique involves separation of the penis into its component parts: the glans cap with neurovascular bundle (dorsally) together with the nondivided or divided urethra and urethral plate (ventrally) and the corpora cavernosa. This maneuver enables an excellent correction of curvature, especially if it is located in the distal third of the corporal bodies and glans tilt. With this technique, substitution urethroplasty can be avoided or its extent, decreased. It enables penile enlargement, above all its lengthening, which is a significant gain in small penises with hypospadias. The patients were followed for 3-23 months (mean 16 months). Straightening of the penis was achieved in all cases without recurrence of curvature. In 37 patients penile disassembly combined with extensive urethral mobilization solved the problem of hypospadiac meatus without the need to form a neourethra. Complications related to urethroplasty included four urethral stenoses, two fistulas, and three diverticula. There was no injury to the neurovascular bundle and urethra. Sensitivity and erection were preserved in all patients. Penile disassembly is an optimal technique for repair of hypospadias with severe curvature and small hypospadiac penises. Real penile augmentation is possible with this technique.