Telescoping the Dorsal Hood in Hypospadias Surgery: An Innovation to Preserve Maximal Penile Skin.

OBJECTIVE

To describe a new technique or adjunct-telescoping the dorsal hood-with a view to banking excess skin on the penile shaft in hypospadias surgery. This would help if redo surgery, not a rare occurrence, is required in the future.

METHOD

A review of a prospectively maintained database of hypospadias surgeries conducted between 1997 and 2023 by a single surgeon. After the hypospadias repair, instead of excising the dorsal hood and suturing the ventral penile skin in the usual way, a skin hook is applied on the ventral penile skin in the midline. As the skin hook is pulled down towards the scrotum, anywhere from 1 to 4cm, it telescopes the dorsal hood down the penile shaft and also pulls in dorsal skin ventrally. (Technique described more fully in the manuscript) RESULTS: Around 1084 patients were operated for hypospadias over these 27 years. Telescoping of the dorsal hood was used in all patients, and in the 126 with proximal hypospadias, none had any skin of the dorsal hood excised! Sixty-two patients presented later with 73 fistulae which were operated on. Of note, no patient needed more than 2 surgical attempts for a cure.

CONCLUSION

The dorsal hood is a useful source of not only skin but also underlying vascularised soft tissue. In hypospadias surgery where redo-operations are a predictable reality, preserving any excess skin on the phallus seems sensible. Our innovation of telescoping the dorsal hood achieves this goal nicely and takes only a few minutes to perform.