Penis

Abstract

Hypospadias surgery has developed into a well defined art and science. With improving functional results, the challenge is now to obtain the optimal cosmetic result to provide patients with a penis of normal function and appearance. Major changes over the past twenty years have contributed to the improved functional and cosmetic results of hypospadias surgery. These changes include: Preservation of the urethral plate, refined technical surgical details, the use of protective intermediate layer and new surgical tecniques. Common hypospadias complications include urethro-cutaneous fistula, meatal stenosis, urethral stricture, recurrent chordee, failure of repair and urethral diverticula, development of hair, psychological and sexual problems. Many factors predisposing to fistula formation are technical and avoidable. Some techniques are prone to meatal stenosis, for example the Tubularised Incised Plate urethroplasty. Popular techniques for re-do surgery include: redo Mathieu, Thiersch-Duplay and lateral based flap. The use of healthy tissue is of paramount importance. In the absence of local healthy tissue, buccal mucosa or skin graft may be justified in selected cases. © 2009 Springer-Verlag.