(Single stage urethroplasty or staged correction of anomaly-chordee correction followed by urethroplasty after one year)
After induction of GA and painting draping, a stay suture is applied at the tip of glans and two lateral stay sutures or dorsal preputial hood. An infant feeding tube preferably No 8 Fr. Is inserted within urinary bladder cia ectopic urethral meatus. The decision of the single-stage or staged procedures is undertaken. Usually in distal types or middle types of Hypospadias cases, single stage surgery is preferred but in more proximal cases or penoscrotal/scrotal types, staged surgery is undertaken.
For single-stage urethroplasty, the urethral plate is marked with a width of about 14-16 mm, and a U-shaped incision encircling the ectopic urethral meatus was made extending distally up to the proposed site of neourethral meatus. Creating glans wings on both sides. A tourniquet is usually applied at the base of the penile shaft, to minimize bleeding during dissection. This urethral plate was dissected free from lateral penile skin and at sub coronal region, the incision is extended circumferentially to deglove the penile shaft up to its base. The urethral plate is tubulized over infant feeding tube in 2 layers by 60 to 70 sutures of vicryl. An intermediate layer to cover this urethral tube is dissected from the inner aspect of the dorsal prepucial hood maintaining its blood supply and transferred over the urethral tube. A fish mouth new urethral meatus is refreshened, glans wings are sutured over urethral tube. Byar’s flaps are made by dividing the outer layer of the dorsal penile hood and transferred from both sides ventrally to cover the deficit of ventral penile shaft. The mucocutaneous subcoronal sutures are applied in between subcoronal mucosa to skin to get an appearance of circumcised penis. The tourniquet is released, and pressure dressing is applied with fixation of infant feeding tube to stay suture of tip of glans to keep urinary drainage in postoperative period.
If there is significant chordae, the fibrous tissue causing chordae is released or dissected out. The tourniquet test is undertaken to assess correction of chordate. This test includes applying a tourniquet at the base of degloved penile shaft and injecting normal saline within crura(Corpora cavernosa). If chordate is still there, then dorsal tunica plication (DTP) is undertaken, where a strip of about 8-10 mm or dorsum of penile shaft, at its maximum curvature, on both sides of midline, protecting dorsal neurovascular structure are buried. Again Byar’s flaps are made and transferred to the ventrum of the penile shaft to cover the skin deficit. After 1 year, Byar’s method of Urethroplasty is undertaken for urethroplasty.