Last updated: 02/17/2009

Correction of hypospadias in boys

The specific surgical procedure used depends on the severity of the hypospadias. The objectives of surgery always include widening the urethral meatus; correcting chordee, if present; reconstructing...

the missing part of the urethra; and making the external genitalia look as normal as possible. Most repair procedures take between one-anda-half and three hours, and are performed under general anesthesia. Mild hypospadias can be corrected in a one-step procedure known as a meatal advancement and glanduloplasty, or MAGPI. In a MAGPI procedure, the opening of the urethra is moved forward and the head of the penis is reshaped. More severe hypospadias can also be corrected in one operation, which involves degloving the penis (separating the skin from the shaft) in order to cut the bands of tissue that cause chordee, and constructing a new urethra that will reach to the tip of the penis. The specific technique of reconstruction is usually decided in the operating room, when the surgeon can determine how much tissue will be needed to make the new urethra. In some cases, tissue must be taken from the inner arm or the lining of the mouth. In a few cases, the repair may require two or three stages spaced several months apart.

There is some remaining disagreement among professionals regarding the best age for hypospadias repair in boys. Most surgeons think the surgery should be done between 12 and 18 months of age, on the ground that gender identity is not fully established prior to toilet training and the child is less likely to remember the operation. Some doctors, however, prefer to wait until the child is about three years old, particularly if the repair involves extensive reconstruction of the urethra.

Recent advances in hypospadias repair include the use of tissue glues and other new surgical adhesives that speed healing and reduce the risk of fistula formation. In addition, various synthetic materials are being tested for their suitability in constructing artificial urethras, which would reduce the risk of complications related to skin grafting.

Correction of hypospadias in girls

The most common surgical technique for correcting hypospadias in girls is construction of a new urethra that opens to the outside of the body rather than emptying into the vagina. Tissue is taken from the front wall of the vagina for this purpose.