54332 1-stage proximal penile or penoscrotal hypospadias repair requiring extensive dissection to correct chordee and urethroplasty by use of skin graft tube and/or island flap

Name of the Procedure:

1-Stage Proximal Penile or Penoscrotal Hypospadias Repair with Extensive Chordee Correction and Urethroplasty using Skin Graft Tube and/or Island Flap.

Summary

This surgical procedure is designed to correct severe cases of hypospadias, a condition where the opening of the urethra is located on the underside of the penis rather than at the tip. The operation involves straightening the penis and reconstructing the urethra using a skin graft or tissue flap.

Purpose

The purpose of this surgery is to correct the placement of the urethral opening, ensure the penis is properly aligned, and restore normal urinary function and appearance. The goals include achieving a straightened penis and a properly located urethral opening to reduce complications such as difficulty urinating or infections.

Indications

This procedure is indicated for patients with severe hypospadias, particularly those with significant curvature (chordee) of the penis, and those whose urethral opening is located near the scrotum (penoscrotal). Candidates typically include infants and young children diagnosed with this condition.

Preparation

• Patients may be required to fast for several hours before the surgery.
• Medication adjustments might be necessary, especially if the patient is on blood thinners.
• Preoperative assessments may include a physical examination, blood tests, and imaging studies such as ultrasound.

Procedure Description

1. Anesthesia: The procedure is performed under general anesthesia.
2. Incision and Dissection: A circumferential incision is made around the penis. Extensive dissection is carried out to expose and correct the chordee.
3. Urethroplasty: The new urethra is constructed using a skin graft tube or an island flap technique. This involves creating a tubular structure from the patient's skin or tissue.
4. Positioning and Suturing: The newly constructed urethra is positioned and sutured in place, ensuring proper alignment and functionality.
5. Closure: The surgical site is closed with sutures, and dressings are applied.

Tools and Equipment:

• Scalpel, scissors, and forceps for dissection.
• Suture materials for closure.

• Grafting instruments for handling skin grafts or tissue flaps.

  Duration

  The procedure typically takes about 3 to 4 hours.

Setting

This surgery is performed in a hospital operating room.

Personnel

• Pediatric urologist or specialist surgeon.
• Anesthesiologist.
• Surgical nurses and assistants.

Risks and Complications

• Common risks include bleeding, infection, and swelling.
• Rare but possible complications involve urethral fistula (an abnormal connection) or strictures (narrowing of the urethra).

Benefits

The expected benefits include correction of the urethral opening, a straightened penis, normal urinary function, and improved cosmetic appearance. Positive results are usually noticeable soon after recovery.

Recovery

• Postoperative care includes monitoring for infection, managing pain, and ensuring proper wound care.
• Recovery time generally spans several weeks, with activity restrictions during this period.
• Follow-up appointments are necessary to monitor healing and function.

Alternatives

Alternative treatments for hypospadias include other surgical techniques such as two-stage repairs or using different tissue sources for urethral reconstruction. These alternatives may vary in complexity, recovery time, and outcomes.

Patient Experience

Patients may experience some pain and discomfort post-surgery, which can be managed with prescribed pain medication. Instructions for maintaining comfort and hygiene are provided to aid in smooth recovery.