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47 - Hypospadias

from Part V - Urology

Published online by Cambridge University Press:  08 January 2010

Laurence S. Baskin
Department of Urology, UCSF Children's Medical Center, University of California, San Francisco, USA
Mark D. Stringer
University of Otago, New Zealand
Keith T. Oldham
Children's Hospital of Wisconsin
Pierre D. E. Mouriquand
Debrousse Hospital, Lyon
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The treatment of hypospadias has a long and colorful history dating back to AD 100–200, when Heliodorand Antyl is credited with the first surgical management. Since that time, the study of hypospadias has evolved into a subspecialty within pediatric urology, hypospadiology.

In Western civilization the incidence of hypospadias is reported to be increasing. A leading hypothesis which is under investigation is maternal exposure to environmental pollutants or endocrine disruptors.

Modern techniques have evolved from the myriad of operations described by the pioneers of hypospadias surgery. An understanding of these techniques is germane to present-day practice. We have now come full circle to accept the multistep operations for severe hypospadias and redo surgery which historically had been the procedure of choice. It is no longer taboo to consider a two-stage approach as opposed to repairing all hypospadias with a single operation.

Historically, the first stage of hypospadias surgery consisted of penile straightening. This was followed by a second-stage urethroplasty using various techniques such as ventral skin tubes (Thiersch-Duplay, flip flaps, Mathieu, Ombredanne and Beck) or urethral mobilization (Beck–Hacker). Alternatively, Dennis Browne buried a strip of epithelium for subsequent tubularization. Blair and Byars championed the vertical split of the dorsal hood rotated to the ventrum and advanced onto a split glans for subsequent tubularization. This was the most popular repair and is similar to the two-stage approach advocated today.

Pediatric Surgery and Urology
Long-Term Outcomes
, pp. 611 - 620
Publisher: Cambridge University Press
Print publication year: 2006

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