The dorsal inlay graft for hypospadias repair

Purpose: Hypospadias is a common genitourinary anomaly affecting every 1/30 0 male newborns. The goals of hypospadiac surgery include a straight penis with a urethral meatus at the tip of the glans, a well vascularized neouret hra of adequate caliber with a solid, straight urinary stream and achieveme nt of sexual function when mature. Current theory advocates preservation of the urethral plate with chordee correction. Hypospadias repair without an adequate urethral plate to roll into a tube requires longitudinal incision of the plate or a transverse preputial island flap. We describe a technique of 1-stage urethroplasty using an inner preputial based dorsal inlay graft . Materials and Methods: After the penis is degloved and chordee corrected in cisions are made bilaterally along the urethral plate from the native ureth ral meatus to the glans tip. The urethral plate is incised longitudinally. A graft harvested from the inner prepuce is defatted and sutured onto the i ncised urethral plate. The neourethra is rolled into a tube in Thiersch-Dup lay fashion. Results: This technique was used in 32 patients. The original urethral meat us was coronal to penoscrotal and chordee release was performed concomitant ly. At 21 months of followup no patient had a stricture, fistula or diverti culum at the inlay graft site. Conclusions: This technique successfully fulfills all traditional hypospadi as repair criteria. We believe that the dorsal inlay graft after incision o f the urethral plate is a rapid, easy and successful addition to the armame ntarium of the "hypospadiologist.".