Operations on previously operated patients with hypospadias.

The therapy of severe degrees of hypospadias is exclusively surgical. A great number of different methods have been described; nevertheless, only a few techniques have proved successful. Between 1976 and 1980 21 children with various forms of hypospadias were admitted to our department for primary operation. Nineteen of these 21 children had to have a straightening operation. In 2 children a more pronounced glans defect was corrected in one session by Ombrédanne's method. During the same period 9 patients were admitted for secondary corrections, having been operated on elsewhere for hypospadias. In two patients aged 6 and 7 years respectively, several fistulae had to be closed. In 7 patients a complete secondary correction had to be performed in at least two sessions. The average age of these 7 patients was 19,4 years at the time of the secondary operation. Secondary corrections are also indicated in cases of multiple fistulae, of unremedied chordee, underdevelopment or an abnormal position of the penis, in cases of strictures in the area of the reconstructed urethra, and, finally, in cases with hairball stones due to hair formations on the skin. The fistulae following the reconstruction of the urethra are closed using sliding grafts from the penis or penoscrotal skin. In extensive fistulae, as well as pronounced strictures of the reconstructed urethra, a complete Johansson (1953) procedure is necessary. In large secondary corrections, there are many cases in which the entire armamentarium of plastic surgery must be utilized.