Reconstruction techniques
For capitate and stem hypospadias, tubularization of the urethral platform with its dissection (Snodgrass/TIP) is more often used: a tube is formed from the own mucosa to the apex of the head, covered with a flap of the fleshy membrane to prevent fistulas, the head is sutured over the new urethra. If there is a lack of space, a foreskin flap is used (onlay, Mathieu). Proximal forms with curvature require first straightening (sometimes with a graft), then creation of the urethra - often in two stages, 6 months apart. The foreskin is reconstructed or removed as desired. Complications (fistula, stenosis) occur in 5–15% and are corrected with minor operations after 6 months.
Meatostenosis
Narrowing of the external opening of the urethra occurs after inflammation (balanitis, lichen), trauma, circumcision in infants and is manifested by a thin stream, upward deviation of the stream, straining, and drops of blood at the end of urination. A meatotomy is a simple outpatient surgery under local anesthesia that removes the narrowing in 15 minutes.
Hypospadias
A congenital anomaly in which the opening of the urethra does not open at the top of the head, but lower - on the shaft, at the scrotum or perineum, often with curvature of the penis and a “hood” of the foreskin. The operation restores the urethra to the apex, straightens the penis and gives it a normal appearance; The optimal age is 6–18 months, but the operation is performed on both adolescents and adults. The result for distal forms is 90–95% in one operation.
