Hypospadias repair and urethroplasty
Hypospadias repair and urethroplasty are surgical procedures aimed at correcting congenital defects of the urethra, which is the tube that allows urine to exit the body. Hypospadias is characterized by an abnormal opening of the urethra on the underside of the penis, and can vary in severity. The surgical correction typically involves a "flip-flap" technique, where incisions are made, and skin is repositioned to create a functional urethra at the correct anatomical location. This procedure is usually performed under general anesthesia, and may involve the placement of a catheter, though opinions vary on its necessity.
Urethroplasty can also address other urethral defects, such as those resulting from incomplete embryonic development. While complications like infection and stricture can occur, they are relatively rare, and the overall success rate for these surgeries is high. Early intervention, ideally before the age of three, is beneficial from a psychological perspective. Additionally, urethroplasty plays a role in gender affirmation surgeries, helping individuals achieve physical alignment with their gender identity. These procedures remain significant in both pediatric urology and in the context of gender-affirming care.
Hypospadias repair and urethroplasty
Anatomy or system affected: Genitals, reproductive system
Definition: Urethroplasty is any plastic surgery performed on the urethra; one of these procedures is the repair of hypospadias, the presence of an abnormal opening in the male urethra.
Indications and Procedures
Urethroplasty is performed to correct defects of the urethra, the tube leading from the bladder to the outside of the body through which urine exits the body. Hypospadias is a congenital defect of the distal end of the urethra in which it opens on the underside of the penis instead of at the tip. Less commonly, the opening can occur lower down on the underside of the penis or in the scrotum. Hypospadias is also associated with abnormalities in the kidneys. Epispadias, another rare birth defect, is also indicated for urethroplasty.
The correction of hypospadias involves a technique known as a “flip-flap” repair: two incisions on the undersurface of the glans and shaft of the penis are made, and skin from the glans is fashioned into an opening that is anatomically normal. The operation is usually done under general anesthesia.
The lines for both incisions are drawn, and incisions are carefully made to avoid damaging adjacent structures and erectile tissue. The prepuce is released from the body of the penis. A V-shaped flap is cut from the skin immediately below the hypospadias. The flap is rotated, and one side is sutured into one of the incisions made in the glans. The other side is similarly inserted into the other incision and sutured in place, forming a tube that extends the urethra. Excess skin from the prepuce is removed; the prepuce is sutured back into position on the shaft of the penis. The skin from the underside of the penis is brought together over the repaired urethra and sutured together. A catheter is frequently (but not universally) placed in the urethra and kept in place for up to two weeks. Some surgeons believe that the presence of a catheter helps to establish the new urethra. Others think that it only contributes to postoperative holes (fistulas) and do not use it, allowing the patient to urinate immediately through the newly constructed tube. The patient may return to the surgeon’s office in a week for a postoperative check and the removal of sutures.
Another type of urethroplasty is the surgical repair of a discontinuity in the male urethra. Most commonly, this defect occurs on the underside of the penis and is attributable to the incomplete closure of the skin portions that normally fuse over the urethra during embryonic development. The technique is similar to that described above. Under general anesthesia, skin is removed from the prepuce of the penis and is sutured in place over the defect, closing the opening. A catheter may or may not be inserted. The patient returns to the surgeon’s office in a week for a postoperative check and the removal of sutures.
In the twenty-first century, gender affirmation surgery, surgically altering one’s genitals to match their gender identity, became increasingly common and urethroplasty became part of the suite of surgeries used in many gender transformations and realignments.
Uses and Complications
The techniques associated with urethroplasty are used to repair congenital defects. Complications from these procedures are unusual, but they may include infection and stricture. Such problems can be avoided with careful attention to the finer details of the surgery. Urethroplasty has an overall high success rate for patients.
The need for urethroplasty and hypospadias repair is unlikely to disappear. From a psychological standpoint, it benefits the patient to repair hypospadias as early in life as possible, preferably before the age of three.
Bibliography
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