Hypospadias Repair: Current Experience Using Operating Microscope

Lee, Jin Haeng; Kim, Kwang Myung

Abstract

Currently improving results of hypospadias repair depend on careful application of surgical principles. Optical magnification. microsurgical instruments, fine suture materials, less reactive tubes and bio-occlusive dressings have been used to decrease postoperative complications requiring secondary surgery. We evaluated the effectiveness of microscopic surgery which was performed in 28 children with hypospadias from December, 1991 to June, 1994. Nine patients underwent hypospadias repair before 2 years-old whereas 19 patients after 2 years-old, whose success rate was 78% and 63% respectively. One-stage repair was performed in 19 patients and two-stage repairs in 9 patients, whose success rate was 69% and 67% each other. In chronological review, success rate was 50%, 29%, 77% and 100% in 1991, 1992, 1993 and 1994 respectively, which showed a rapidly increasing success rate. According to dressings and catheters, excellent results were obtained when we used Duodenum dressings and silastic Foley catheters, of which each complication rate was 7% and 0% respectively. In 9 patients(32 %), we experienced 20 surgical complications which included urethrocutaneous fistula (9), meatal stenosis(4) stricture(2) and others(5). The success rate of fistula repair was 61% in initial, 40% in secondary and 33% in tertiary repair. From these data, we think that the use of operating microscope with microsurgical principles and proper postoperative managements can improve success rate of hypospadias repair.