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Praxis für Urologie
Dr. med. Aref El-Seweifi
Forum Zehlendorf
Teltower Dam 35
D-14169 Berlin
Deutschland

Tel.: +49 30 804 90 950
Fax: +49 30 804 90 951
info@masculine.de
Hypospadius
The mal development of the urethra leads to defective urination and the inability of insemination; i.e. inability to ejaculate inside the vagina which may lead to infertility. Another important disadvantage is the deterioration of the psychological development of the child starting at school age. That is why there is a lot of attention paid to the condition and its operative correction in particular before school age.

Hypospadius is described as the failure of development of a part of or all of the urethra during the development of the baby inside the uterus. The failure may be in part confined to the end of the penis „distal hypospadius, to the middle of the shaft „peno scrotal“ or the base of the penis „scrotal or proximal hypospadius“. The urethra develops from a special plate on the lower aspect of the penis. This is called the urethral plate. Failure in the development and tubularization of this plate results in hypospadius.

Hypospadius is a big challenge for the surgeon. It means examining the patient and planning which operations technique should be done under strict sterilization in a suitable time to keep the time of anesthesia to a minimum. The challenge is to find a hairless part of skin with a suitable blood supply to cover the defect preserving the cosmetic appearance of the penis. The penis should be straight, functional and cosmetically good. The site of skin chosen for the coverage of the defect may be the foreskin, the side of the penis, the inside of the upper arm, the mucus membrane of the mouth or recently AlloDerm with patients own cells (still experimental).

The child suffering from hypospadius lyes on his back. The penis is sterilized. The area is studied again in order to plan for the harvesting of the skin, which may be a free part of skin or a part attached to its blood supply rotated to the area to be restored. The penis is artificially erected to discover any curvatures that should be corrected in straightening it.

The skin is laid on the defected area as a sheet which should be wide enough to permit a catheter of 10 Ch. diameter and to avoid any narrowing of the future urethra or meatus (outer opening of the urethra). The covering skin is then sutured to the remaining plate of the urethra in a water tight double layer using fine sutures and microsurgical magnification. The new urethra is then covered with the mobilized skin of the penis. The penis is wrapped in compression bandages.