Repair Hypospadias

Introduction
a. Definition
An abnormal state of development of the anterior urethra where the external urethral meatus located on the ventral and is located more proximal than the normal location and was accompanied on the distal part of firosis MUE that cause crooked penis (chordae).
b. Scope
Hypospadias in the distal, midshaft and proximal penis.
c. Operation Indication
The purpose hypospadias surgery is to straighten the penis, allowing the process of micturition while standing and to increase fertility.
d. Contra indications of operation (no)
e. Differential diagnosis (no)
f. Examination Support
Only by clinical examination
Engineering Operations
Optimal operating time is when children aged 3 to 18 months. At this time children will have amnesia of the surgical procedure and 70-80% of abnormalities can be handled without the need to be treated.
There are two stages of hypospadias surgery, the first is the excision Korde and tunneling, and the second is the reconstruction of the urethra (uretroplasty)
Excision Korde
After incision of hypospadias has been done and the flap has been lifted, the entire network can result in bent lifted from around the meatus, and below the glans. After the artificial erection test was performed. When Korde persists, then further resection is required.
Urethroplasty
There are many techniques that can be used for urethroplasty, but that will be discussed is a fairly common technique used MAGPI.
MAGPI (meatal Advancement and Glanuloplasty Incorporated)
MAGPI technique can be used for patients with distal hypospadias glanular. Once the penis is seen straight on artificial erection test, sirkumsis incision performed. Skin hooks are placed at the edge of the end of the channel glanular urethra and then withdrawn to the lateral direction. This movement can increase the transverse bands of the mucosa which will be a longitudinal incision in the midline. Incision on the dorsal wall of the urethra glanular dengna would eventually be closed with chromic catgut sutures transverse 6-0. Skin hooks are placed on the skin edges of the corona at the ventral midline. With traction distally, tip of the glans is pulled forward and stitched on the midline with sutures subkutikuler. Epithelium of the glans was closed with interrupted sutures. Excess skin of the dorsal prepusium be sewn to skin closure.
Complications Surgery
Short-term

    * Local edema and hemorrhage bintk spots can occur immediately after surgery and usually do not cause significant problems
    * Postoperative Hemorrhage is rare and can usually be controlled dengna dressing press. Not infrequently this requires re-exploration to remove the hematoma and to identify and address the source of bleeding.
    * Infection is a fairly rare complication of hypospadias. With skin preparation and perioperative antibiotics this can be prevented.
Long-term

    * Fistula: Fistula uretrokutan is a major problem that often arises in the operation hpospadia. Fistulas rarely close spontaneously and can be repaired dengna layered closure of a local skin flap.
    * Meatus stenosis: stenosis or narrowing of the urethral meatus may occur. The flow of urine which can lead to reduced vigilance over the meatus stenosis.
    * Stricture: This condition can develop as long-term complications of hypospadias surgery. This situation can be corrected with surgery, and may require an incision, excision or reanastomosis.
    * Diverticula: Urethral Diverticula can also form characterized by the development of the urethra during urination. Stricture at the distal obstruction can result in the flow and ended in urethral diverticula. Diverticula can form even though there is no obstruction in the distal part. This can occur related to the graft or flap in hypospadias surgery, which propped up of muscle and subcutaneous tissue from the urethra of origin.
    * The presence of hair on the urethra: The skin containing hair follicles used in the reconstruction of hypospadias be avoided. When the skin is associated * with the urethra, this can cause problems in the form of urinary tract infection and stone formation during puberty. Usually to solve a laser or cautery is used, even if pretty much done on the excision of skin containing hair follicles and then repeated hypospadias repair.
Mortality
Very low
Postoperative treatment
- Day-3 post-operative care performed with a removable splint injuries
- Maintain a urinary catheter ± 10-14 days post-surgery
Follow Up
After surgery patients were given a cold compress on the area of ​​operations during the first 2 days. This method can reduce edema and pain as well as keeping the area clean operation. Patients who use suprapubic catheter, urethral sten may also require a small and may be revoked on the fifth postoperative day. In patients who use the tube graft or flap prepusium, micturition process is done through percutaneous suprapubic catheter. Depending on the wound healing process, the catheter was closed on day 10 for experiment micturition. If there is difficulty in this method was repeated 3-4 days later. If up to 3 weeks the fistula persists, micturition process continued as usual after the patient disarankkan to improve operating results 6 months later when the inflammatory process has disappeared. Usually a small fistula may close spontaneously.
After the trial micturition, the patient can bathe as usual. Dressing can be separated spontaneously. After the release of sten, parents were asked to keep the meatus remain open using Neosporin eye ointment jar lid so that the crust at the meatus does not cause an obstruction distal to develop into a fistula.