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Maher et al. Plast Aesthet Res 2017;4:64-9 Plastic and
DOI: 10.20517/2347-9264.2016.105
Aesthetic Research

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Original Article Open Access

Hypospadias: an algorithm for repair with

the aid of the microscope in 102 patients

Mohamed Maher , Maria Chasapi , Milind Dalal 2
2
1
1 University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, B15 2TH Birmingham, UK.
2 Lancachire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, PR2 9HT Preston, UK.
Correspondence to: Mr. Mohamed Maher, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, B15 2TH
Birmingham, UK. E-mail: mohamed.maher@doctors.org.uk

How to cite this article: Maher M, Chasapi M, Dalal M. Hypospadias: an algorithm for repair with the aid of the microscope in 102 patients.
Plast Aesthet Res 2017;4:64-9.
ABSTRACT
Article history: Aim: To demonstrate an algorithmic approach to hypospadias repair with the aid of the
Received: 10-12-2016 surgical microscope as a teaching aid, as well as an ergonomic tool. Methods: One hundred
Accepted: 18-04-2017 and two patients were operated on between 2009 and 2013, all by the senior surgeon (M
Published: 27-04-2017 Dalal). This is a retrospective review of results in the case series. The procedures used were
one stage repair with no incision of the urethral plate, or the two stage Bracka repair. Results:
Key words: Fifty-six patients underwent the one stage procedure and 46 patients underwent the two stage
Hypospadias, Bracka repair. Early complication rate was 4.9% (n = 5) and late complication rate was 10.7%
one stage/two stage hypospadias (n = 11). The fistula rate specific to one stage and two stage procedures was 5.3% (n = 3) and
repairs, 13% (n = 6) respectively. Conclusion: A structured approach to hypospadias surgery will aid
urethrocutaneous fistula, the surgeon in choosing the appropriate procedure for the appropriate patient. The authors
hypospadias algorithm, have chosen to use 2 types of repair for all hypospadias subsets based on the algorithm.
microscope They find the microscope an invaluable teaching aid, whilst at the same time providing an
ergonomic benefit, and providing a wide range of surgical site magnification.

INTRODUCTION is the abnormal position of the ventral urethral meatus,
and to many, this position is related to complexity of the
Hypospadias surgery has been performed for case and the type of repair chosen; when in fact there
decades and centuries. It has evolved quite rapidly are other associated morphological aberrations that
and there have been many procedures described should be taken into consideration when considering
along with their modifications. It remains a relatively repair. Common meatal positions are distal penile
common condition, occurring in 1:300 live births. 70%, mid-penile 10%, and proximal types 20%. We
[2]
[1]
Hypospadias is characterised by the presence of an follow an algorithm, which helps in choice of repair
abnormally sited ventral urethral meatus, a dorsally irrespective of the meatal site. The surgical procedure
hooded prepuce, and varying degree of penile ventral in itself requires magnification and a bloodless field to
curvature “chordee”. The main aspect in its diagnosis execute a successful repair.

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