Hypospadias Surgery
The treatment for hypospadias is surgical repair. Hypospadias is generally repaired for functional and cosmetic reasons. The more proximally ectopic the position of the urethral meatus, the more likely the urinary stream is to be deflected downward, which may necessitate urination in a seated position. Any element of chordee can exacerbate this abnormality. Fertility may be affected. The abnormal deflection of ejaculate may preclude effective insemination, and significant chordee can preclude vaginal insertion of the penis or can be associated with inherently painful erections. Minor cases of hypospadias, in which the meatus is located up toward the tip of the glans, may not require surgical repair and may simply be managed with observation. It must be kept in mind, however, that although the most minor forms of hypospadias are insignificant in physiologic terms, they too may merit repair on the basis of the potential psychological stress associated with having a genital anomaly.
Surgical Care
The goals of surgical treatment of hypospadias are as follows:- To create a straight penis by repairing any curvature (orthoplasty)
- To create a urethra with its meatus at the tip of the penis (urethroplasty)
- To re-form the glans into a more natural conical configuration (glansplasty)
- To achieve cosmetically acceptable penile skin coverage
- To create a normal-appearing scrotum
The resulting penis should be suitable for future sexual intercourse, should enable the patient to void while standing, and should present an acceptable cosmetic appearance.
Urethroplasty Surgery
The open reconstruction of urethral stricture disease, also called urethroplasty, may involve surgery to remove the involved segment and re-attach the two normal ends. This is called excision and primary anastomosis. This procedure is best suited for short strictures involving the bulbar or membranous urethra in particular. When this repair is not possible, tissue can be transferred to augment and therefore widen the narrow segment to a normal caliber. For example, the urethra can be augmented using penile skin. Other tissues that can be used to reconstruct the urethra include a graft of buccal mucosa (skin inside the cheek). When the above procedures are not an option, alternatives include a two-stage repair where a buccal mucosa and/or a split-thickness skin graft is placed along the undersurface of the penis, and later rolled into a new urethra (neo-urethra). The choice of repair is individual and influenced by the length and location of the stricture, the availability of local tissue, and other factors.
Recovery after Urethral Stricture Surgery
Subsequent to surgery, the length of hospitalization varies but generally does not exceed 5 days. Patients seldom have any significant pain or swelling in the penis or scrotum. However, if a buccal mucosa graft is harvested from the inside of the cheek, it is not uncommon for the mouth to be sore. This slowly resolves day by day, and pain medications are given as needed. Patients can immediately resume a normal diet after surgery. However, patients who undergo buccal mucosa graft harvests generally prefer a soft diet initially. When patients are discharged, they are encouraged to remain inactive for several weeks. Often, catheters remain for 2-3 weeks. We then remove the catheters after filling the bladder with x-ray contrast. Then, as the patient voids, a film is taken. This is a voiding cystourethrogram (VCUG). If the urethra is nicely healed, the patient leaves the office "tube free" and resumes normal urination. The vast majority of patients report a "night and day" difference in their stream, and often compare their stream to a “fire hose” as the change is often dramatic.