Hypospadias repair: Recent concept and development in surgical techniques

Hypospadias is one of the most common congenital anomalies defined by abortive development of the urethral spongiosum and the ventral prepuce. The current standard of care for hypospadias includes not only a functional penis adequate for sexual intercourse and urethral reconstruction offering the ability to stand to urinate, but also a satisfactory cosmetic result. The techniques of hypospadias surgery continue to evolve. The major technical advances in hypospadias surgery that have improved surgical outcomes are 1) Preservation of the urethral plate, 2) Incision of the urethral plate, 3) Dorsal midline plication, 4) Deepithelized urethroplasty dartos flap coverage, and 5) Two stage alternative techniques. Tubularized incised plate repair has been the mainstay for distal hypospadias. In cases of proximal hypospadias, one-stage repairs such as the Duckett repair or the Koyanagi repair have been well established, while two-stage repairs remain important alternatives. Whether dorsal plication or ventral lengthening should be used to correct penile curvature is still controversial, and long-term results are required. This article reviews the new concept and development in surgical techniques.