Hypospadias: an algorithm for repair with the aid of the microscope in 102 patients

Aim: To demonstrate an algorithmic approach to hypospadias repair with the aid of the surgical microscope as a teaching aid, as well as an ergonomic tool. Methods: One hundred and two patients were operated on between 2009 and 2013, all by the senior surgeon (M Dalal). This is a retrospective review of results in the case series. The procedures used were one stage repair with no incision of the urethral plate, or the two stage Bracka repair. Results: Fifty-six patients underwent the one stage procedure and 46 patients underwent the two stage Bracka repair. Early complication rate was 4.9% (n = 5) and late complication rate was 10.7% (n = 11). The fistula rate specific to one stage and two stage procedures was 5.3% (n = 3) and 13% (n = 6) respectively. Conclusion: A structured approach to hypospadias surgery will aid the surgeon in choosing the appropriate procedure for the appropriate patient. The authors have chosen to use 2 types of repair for all hypospadias subsets based on the algorithm. They find the microscope an invaluable teaching aid, whilst at the same time providing an ergonomic benefit, and providing a wide range of surgical site magnification. ABSTRACT