Hypospadias

Hypospadias refers to a condition where the urethral opening is not on the tip of the penis:

 

Boys born with hypospadias usually have:

  1. Urethra opening not on the tip
  2. “Partial Circumcision” or “Dorsal Hood”
  3. Ventral curvature (penis curves down)

 

There are mild cases and severe cases based on how much curvature the penis has and how far away the opening is from the tip:

Also, there is a separate type of hypospadias called MIP (megameatus intact prepuce) hypospadias, where the foreskin is normal and there is no curvature. Hypospadias is usually noted during or after the boy undergoes a circumcision:

 

Hundreds of different type of hypospadias repairs have been described. However, it seems that the best outcomes are achieved by using one repair for mild cases and another repair for severe cases:

  1. Mild cases: TIP repair (Tubulirized Incised plate, Snodgrass repair)
  2. Severe cases: STAG repair (Staged autograft, modified Bracka)

 

For mild cases, the TIP repair provides a normal circumcised appearance with less than 5% chance of complications (need for reoperation):

 

For more severe cases, the STAG repair also provides a normal circumcised appearance with around 15% chance of having a complication requiring more surgery. The STAG repair is done in 2 stages:

  1. Stage 1: curvature is corrected, the skin graft is laid over the penis
  2. Stage 2: 6 months later, the graft is used to form a new urethra.

Case 1:

Case 2:

Case 3:

 

Here is a video of the first stage repair:

And a video of the second stage:

Please comment!

 

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