[Proximal hypospadias].

OBJECTIVE

To evaluate the outcome of surgery in posterior hypospadias.

METHOD

The technique of preservation of the urethral plate is described following three main steps: 1.-The first step is the correction of chordee which is mainly related to the two fibrous and vascular pillars sitting on each side of the urethral plate and representing the division of the atretic corpus spongiosum. Tethering of the urethral plate onto the anterior surface of the corpora cavernosa is another common cause of chordee which can be relieved by untethering the urethral plate from the ectopic meatus up to the glans cap. The urethral plate can be preserved in most cases of posterior hypospadias (35/43) and dorsal plication of the corpora cavernosa is rarely needed. 2.- The second step of this surgery is urethroplasty, which is usually achieved by using a pediculized preputial patch stitched to the urethral plate (onlay urethroplasty). 3.- Penile cover using the skin sleeve technique completes the procedure.

RESULTS

Twenty one per cent fistulae, 1 meatal stenosis, no proximal stenosis are reported and discussed.

CONCLUSION

Preservation of the urethral plate is possible in most posterior hypospadias and permits an onlay urethroplasty which remains to date the most reliable procedure to reconstruct the urethra in posterior hypospadias.