Hypospadias 2 orthoplasty & ttt options and 2nd layer bases step by step oper series for more resources visit: uronotes2012.blogspot.com

1. Hypospadias repair - Part 2
(ttt options, orthoplasty & 2nd layer bases)
M.A.Wadood Aref

2. Hypospadias Options of ttt
according to site
Distal Hypo Middle Hypo Proximal Hypo
• MAGPI (glanular)  OIF (flap) 1 stage:
• Thiersch Duplay or •Thiersch Duplay or • OIF (flap)
TIP (tubularization) TIP (tubularization) • TPIF (flap)
• GAP • Thiersch Duplay or
• Mathieu TIP (tubularization)
• Pyramid (for MIP) 2 stage:
M.A.Wadood Aref

3. Chordee
Causes
• Skin
• Buck’s or Dartos fascia
• Atretic urethra
• Corpora disproportion
• Normal in fetal phallic
development
M.A.Wadood Aref

4. Orthoplasty
• Degloving
• Dissection of atretic C.S. & under urethral plate
• Shortening of long side (no need for plate transection)
• Lengthening of short side (need plate transection)
• Transection of urethral plate (last resort, with or without
lengthening)
M.A.Wadood Aref

5. shorten longer (dorsal) aspect-
1- Nesbitt
• elevate NVB
• excising an ellipse or
ellipses from the
dorsum of the tunica
albuginea,
• closing the defects in
watertight fashion
M.A.Wadood Aref

6. shorten longer (dorsal) aspect
2- T.A.P. plication (modified Nesbitt)
• Elevation of NVB
• Ts parallel incisions
M.A.Wadood Aref

7. shorten longer (dorsal) aspect
3- Baskin suture
• Dorsal midline ts
sutures
• No need to elevate
NVB
M.A.Wadood Aref

8. Lengthening short surface-
1- Heineke-Mikulicz suture
• Not effective
• Ts incision & close long.
M.A.Wadood Aref

9. Lengthening short surface-
2- Dermal graft
• From non-hairy groin
• De-epithelialization
• De-fattening
M.A.Wadood Aref

10. 2nd layer (dartos flap) or (T.V. flap)
M.A.Wadood Aref

11. Thank You
M.A.Wadood Aref