Different Tissues Used for Correction of Hypospadias

Although penile repairs can be grouped into 8 major principles depending on the tissues used, countless variations exist as surgeons continuously modify previous procedures adapted from original principles.

Basic Principles or Tissues for Hypospadias Correction

• Mobilization of the urethra
• Skin distal to the meatus
• Skin proximal to the meatus
• Preputial skin
• Combined prepuce and skin proximal to the meatus
• Scrotal skin
• Dorsal penile skin
• Different grafts

Fig. 5: Different tissues used for hypospadias repair

Urethral Mobilization

• Double Y Glanuloplasty (DYG) by Hadidi (2010)
• First described by Beck and Hacker (1897)
• MAGPI technique by Duckett (1981)
• M-configuration by Arap (1984)
• UGPI modification by Harrison and Grobelaar (1997)

Skin Distal to the Meatus

A. For fully epithelialized neo-urethra:

• Lateral Based Onlay Flap (LABO) by Hadidi (2012)
• U-shaped incision by Thiersch (1869)
• Pyramid repair by Duckett and Keating (1989)
• Glanular hypospadias with cleft glans
• DUG repair by Stock and Hanna (1997)

B. For partially epithelialized neo-urethra (Fig. 6):

• Duplay incomplete urethroplasty (1880)
• Denis Browne technique (1949)
• Hinging of the urethral plate by Rich et al. (1989)
• Snodgrass TIP urethroplasty (1994)

Skin Proximal to the Meatus

• Slit-like adjusted Mathieu (SLAM) by Hadidi (1996, 2004, 2012)
• Meatal-based flap by Wood (1875)
• Omberdanne repair (1911)
• Mathieu repair (1932)
• Mustarde repair (1965)
• Barcat balanic groove technique (1969)

Preputial Skin

• Button holing of prepuce by Thiersch (1869)
• Midline incision of prepuce by Edmunds (1913) and Byars (1955)
• Preputial skin graft to cover ventral defect (Nove-Josserand 1897, Bracka 1995)
• Free skin graft to form neo-urethra (Devine and Horton 1961)
• Preputial Island Flap (Hook 1896, Duckett 1980)
• Onlay Island Flap (Elder 1987)
• Preputial vascular fascia as a protective layer (Retik 1988)