Hypospadias surgery: How it has changed in 40 years

July 1, 2010

It is, in my opinion, truly amazing how far we have come concerning hypospadias repair.

Ventral curve

Still, there were some severe ventral curves that resisted these efforts, necessitating transection of the urethral plate and leading to the use of ventral corporotomy and insertion of grafts made with dermis, tunica vaginalis, small intestinal submucosa (SIS), or other forms of collagen to correct the problem.


There was a time when loss of some of the covering skin was an expected outcome, and agents such as nitroglycerin paste were used in an attempt to improve blood supply to the area. The meatus was left at the coronal sulcus because it was felt that a glanular meatus was likely to stenose. Attempts to bring the meatus to the tip of the penis failed for a number of reasons, the most common being tension on the distal repair. Tunneling methods were also attempted but usually did not succeed. It was not until we recognized that deep incision into the glans allowed closure of the glans over the newly constructed urethra without tension that we routinely could provide a slit-like meatus at the tip of the glans.