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  • 1. Surgical Approach
  • 2. Incision
  • 3. Insert Catheter
  • 4. Dissection
  • 5. Prepare Island Flap for Urethra Formation
  • 6. Construction of Penile Urethra
  • 7. Mobilize Native Urethra for Length
  • 8. Excise Native Urethral Orifice
  • 9. Anastomosis of Native and Constructed Urethral Segments
  • 10. Alignment and Attachment of New Urethral Orifice
  • 11. Suture Corpus Around Penile Urethra
  • 12. Skin Closure
  • 13. Post-op Remarks
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Penoscrotal Hypospadias Repair


Domingo Alvear, MD1; Lissa Henson, MD2; Jaymie Ang Henry, MD, MPH3

1World Surgical Foundation
2Philippine Society of Pediatric Surgeons
3Florida Atlantic University, G4 Alliance

Main Text


Hypospadias is a birth defect where the opening of the urethra is not located in its usual position at the tip of the penis. Instead, the abnormal opening is located anywhere along the underside of the penis. Hypospadias is a common birth defect found in up to 1 in every 200 males. Approximately 90% of cases is the less-severe distal hypospadias in which the urethral opening is found on or near the head of the penis; however, the remainder have proximal hypospadias in which the urethral opening is found on the shaft of the penis, or near or on the scrotum. There are 3 types of hypospadias depending on the location of the urethral opening: in subcoronal, it is located near the head of the penis; in midshaft, it is located along the shaft of the penis; and in penoscrotal, it is located at the junction between the penis and scrotum. Although the cause of hypospadias is unknown, family history, genetics, maternal age over 35, and exposure to certain substances during pregnancy are thought to play a role. Hypospadias is usually diagnosed during physical examination after the birth of the baby. Treatment usually involves surgery to reposition the urethral opening and, if necessary, straighten the shaft of the penis when chordee is present. Most distal, and many proximal, cases of hypospadias are corrected in a 1-stage operation; however, those with the most severe condition where the urinary opening is on the scrotum and associated with downward curvature of the penis are often corrected in a 2-stage operation. The curvature is straightened during the first stage, while the penile urethra is created during the second. Here, we present a 1-stage repair to relocate the urethral opening to the tip of the penis of an adult male with penoscrotal hypospadias.