(1) Hypospadias. A deformity of the penis and malformation of the urethral
wall in which the urinary meatus is located on the underside of the penis, either short of
its normal position at the tip of the glans or on the perineum or scrotum. This condition
is often associated with chordee.
(2) Chordee. A downward bowing of the penis due to the congenital
malformation of hypospadias with fibrous bands.
(3) Epispadias. A condition in which the urethral meatus is situated in an
abnormal position on the upper side of the penis.
c. Operative Procedures.
Chordee repair (Fraser or Nesbit technique).
(a) A transverse incision is made across the penis. Restricted fibrous
tissue is dissected off the undersurface of the penis. Fine plastic scissors, a scalpel
with blade number 10, and fine plastic tissue forceps are needed.
(b) With the penis held forward and the prepuce retracted, the skin is
incised, and a dorsal quadrilateral flap is freed from the body of the penis.
On each side, a narrow penile band of skin is divided.
(d) A transverse buttonhole is made to accommodate the head of the
penis, which is threaded through it.
(e) The proximal edge of the buttonhole is sutured to the mucosa
behind the corona. The preputial flap is trimmed and sutured to the raw area on the
undersurface of the penis.
An indwelling catheter is placed, and the wound is dressed.
(a) The urethra is dilated, and a Malecot catheter number 14 or
number 16 Fr over a sound number 8 Fr is used to accomplish a perineal urethrostomy.
(b) On the ventral side of the penis, the Duplay flap is made to create
the urethra. The edges of the flap are inverted and united over a catheter number 8 or
number 10 Fr with interrupted chromic gut sutures number 5 - 0 or number 6-0 on