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| Name | Proximal Hypospadias - 1 Stage Repair |
| Video Uploader | Video From AUAUniversity |
| Upload Date | This Video Uploaded At 11-07-2019 20:05:52 |
| Video Discription | Proximal Hypospadias - 1 Stage Repair Wesley Baas, MD and Ranjiv I. Mathews, MD Introduction: A ventrally located urethral meatus in a boy is defined as a hypospadias. There are a number of different surgical techniques that have been successfully used to correct hypospadias. This video highlights some of the important steps common to many procedures used for hypospadias reconstruction. Details on Technique: The procedure begins with patient positioning. The child can be placed supine or in a leg open position to allow the surgeon access to the penoscrotal region of the urethra. An exam under anesthesia is performed, taking care to determine the location of the urethral opening as well as an assessment of preoperative chordee. Calibration of the urethra can demonstrate the proximal extent of the thin urethra. A feeding tube or similar stent, is placed into the urethra. A holding suture in the glans is useful for retraction and can be used to secure the stent in place at the end of the case. A circumferential incision is started on the dorsal aspect of the penis and continued around to the ventral urethral meatus. The penile skin is then dissected off the penis down to the base. Extensive dissection on the ventral aspect of the penis can usually suffice to release the chordee completely. To determine if there is residual chordee, an artificial erection is then performed by injecting sterile injectable saline into the corpora with a tourniquet at the base of the penis. If chordee persists despite complete skin dissection, additional modalities for correction will be needed (i.e. plication or corporal grafting). Using the technique described by Snodgrass, the dorsal urethral plate is split in the center to facilitate urethral tubularization. Glans wings are created by incising on each side of the urethral plate. Dissecting the glans partially off of the corpora allows the glans to be wrapped around the neourethra. A vascularized flap can be developed from the dorsal foreskin and used as an additional layer of coverage to the neourethra. The glans is then closed with interrupted sutures. The penoscrotal junction may be fixed by tacking the base of the penis to the suprapubic region. The foreskin is then gradually tailored, usually with rotational skin flaps, to accomplish skin coverage of the penis. The stent is then sutured in place and a double-faced Tegaderm dressing is placed. Both stay in place for a week postoperatively. Results: Multiple techniques have been developed to successfully manage hypospadias. All of the techniques, share some common paradigms that we have attempted to illustrate in the video. Meticulous care with dissection and attention to detail in reconstruction remain the hallmarks for successful outcomes in patients with hypospadias. |
| Category | Education |
| Tags | Pediatrics | teaching | AUA University | urology | surgical | urology surgery video | auauniversity | urology education | Proximal Hypospadias - 1 Stage Repair | AUAUniversity | pediatric urology | hypospadias | proximal hypospadias | AUA Teaching Videos: Proximal Hypospadias - 1 Stage Repair | AUA | surgery | education | AUA Urology Core Curriculum Teaching Videos | urological | AUAU | urologic | American Urological Association university | AUA Teaching Videos | Urology | AUA Teaching video |
