Name of the Procedure:

1-Stage Distal Hypospadias Repair (with or without chordee or circumcision); with urethroplasty by local skin flaps and mobilization of urethra

Summary

This surgical procedure corrects distal hypospadias, a condition where the opening of the urethra is located on the underside of the penis instead of at the tip. The surgery involves creating a new urethral channel using local skin flaps and may include straightening the penis (if chordee is present) and circumcision.

Purpose

The primary purpose is to relocate the urethral opening to its normal position at the tip of the penis, allowing for normal urination. The procedure also aims to rectify any penile curvature (chordee) and may involve circumcision to provide a more traditional penile appearance.

Indications

• Urethral opening located on the underside of the penis.
• Difficulty urinating or abnormal urine stream.
• Presence of chordee (penile curvature).
• Desire for corrective treatment for cosmetic reasons or functionality.

Preparation

• Fasting for a certain period before surgery, typically from midnight the night before.
• Pre-operative physical examinations and blood tests.
• A review of the patient's current medications and potential adjustments, including stopping blood thinners or other interfering drugs.

Procedure Description

1. The patient receives anesthesia to ensure they are pain-free.
2. The surgeon makes an incision around the urethral opening.
3. Skin grafts or flaps are taken from the surrounding tissue to create a new urethral passage.
4. The urethra is repositioned to the tip of the penis.
5. Any existing chordee is corrected by releasing the tight tissues causing the curvature.
6. Circumcision is performed if elected.
7. The surgical area is sutured and sterile dressings are applied.

Duration

The procedure typically takes about 2 to 3 hours, depending on the complexity.

Setting

This surgery is performed in a hospital or surgical center, typically in an operating room environment.

Personnel

• Pediatric or urologic surgeon specializing in hypospadias repair.
• Anesthesiologist.
• Surgical nurses and assistants.

Risks and Complications

• Infection at the surgical site.
• Bleeding.
• Scarring or strictures in the new urethra.
• Fistula formation (abnormal passageways developing).
• Persistent curvature or need for additional surgeries.

Benefits

• Relocation of the urethral opening for normal urination.
• Correction of penile curvature (if present).
• Improved cosmetic appearance and function of the penis.
• Increased confidence and quality of life.

Recovery

• Post-operative care includes pain management and antibiotics to prevent infection.
• The patient may need to wear a catheter for a short period.
• Follow-up visits to monitor healing and remove sutures.
• Full recovery typically takes a few weeks, with most normal activities resuming in 2-4 weeks.

Alternatives

• Observation if the condition is mild and not causing significant symptoms.
• Staged surgical repair if the condition is complex or involves extensive malformations.
• Endocrine therapy in very specific cases involving hormonal imbalance.

Patient Experience

The patient will be under anesthesia during the procedure and should not feel pain. Post-operatively, there might be discomfort and swelling, managed with prescribed medications. The patient will need to follow specific aftercare instructions, including activity restrictions, to promote healing and avoid complications.