Management

It is important to recognize the condition as circumcision is absolutely contraindicated: the dorsal hood of foreskin is a valuable piece of tissue for reconstruction. Uncorrected, the penile curvature and abnormal urination and semen delivery could lead to major psychological and sexual sequelae and infertility. The goal of surgery is to straighten the penis, provide a urethra which opens at its tip and achieve a normal appearance. A variety of techniques have been employed. Most are repaired at around the age of 1 year. A single stage operation is performed except for very severe hypospadias. If chordee is present, this is excised completely. For proper placement of the new urethral opening, a short distance may be covered by meatal advancement and glanuloplasty. In moderate and severe hypospadias, a neourethra has to be fashioned, usually from penile skin which commonly is

Figure 23.7. Phimosis resulting from BXO.

meatal-based or pedicled from the dorsal hood, or by tubu-larizing the urethral plate. Complications include meatal stenosis, urethrocutaneous fistula, stricture, diverticulum, etc. Bladder or buccal mucosa grafts may be needed for secondary procedures.

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