Video Atlas of Hypospadias Surgery

Preface
Contents
Part I: Introduction
	1: Training and Knowledge Transfer in Hypospadias Reconstruction
		1.1	 Introduction
		1.2	 Need to Improve and Standardize Training in Hypospadias Repair
		1.3	 Video-Based Surgical Learning vs. Conventional Methods
		1.4	 The Importance of Hypospadias Surgical Skills Maintenance and Self-Evaluation
		1.5	 How to Use This Surgical Video Atlas?
		References
	2: Ergonomics of Hypospadias Surgery
		2.1	 Introduction
		2.2	 What Is “Ergonomics”?
		2.3	 Execution of Ergonomics Concepts in Hypospadias Surgery
			2.3.1	 Pre-operative Preparation Issues
				2.3.1.1	 Timing and Mental Preparation
				2.3.1.2	 Operation Theatre Position
				2.3.1.3	 Nasal Intubation for Buccal Graft Harvest
			2.3.2	 Intraoperative Ergonomic Concepts
				2.3.2.1	 Technical Skills and Handling
					Sensorial Ergonomics
					Tissue Handling and Suturing Techniques
				2.3.2.2	 Surgical Instruments
					Magnification
					Microsurgical Instruments
					Traction Tools
					Suture Material
					Urinary Diversion
					Tissue Sealants
			2.3.3	 Contemporary Concepts in Team Oversight
		References
Part II: Procedures for the Repair of Distal Hypospadias
	3: Meatal Advancement and Glanduloplasty Incorporated (MAGPI)
		3.1	 Introduction
		3.2	 Indications/Case Selection
		3.3	 Video
		3.4	 Description of the Technique
		3.5	 Postoperative Care
		3.6	 Conclusion
		References
	4: Double Y Glanuloplasty (DYG) Procedure
		4.1	 Introduction
		4.2	 Patients’ Selection
		4.3	 Video Demonstration
		4.4	 Operative Steps
		4.5	 Standard Postoperative Care After Hypospadias Surgery
		4.6	 Tips and Tricks
		4.7	 Results and Conclusion
		References
	5: Tubularized Incised Plate (TIP) Urethroplasty
		5.1	 Introduction
		5.2	 Indications
		5.3	 Video Demonstration
		5.4	 Steps of the Procedure [1]
			5.4.1	 Partial Penile Degloving [1]
			5.4.2	 Mobilization of Urethral Plate [1]
			5.4.3	 Incising the Urethral Plate [1]
			5.4.4	 Tubularization of the Urethral Plate [1]
			5.4.5	 Spongioplasty [1, 5, 6]
			5.4.6	 Double Breasting Spongioplasty (Figs. 5.8a–f and 5.9a–f) [5, 7]
			5.4.7	 Glansplasty [1]
			5.4.8	 Frenuloplasty [1]
			5.4.9	 Dartosorraphy [1]
			5.4.10	 Prepucioplasty [1, 8–10]
				5.4.10.1	 Measuring the Adequacy of Prepuce
				5.4.10.2	 Technique (Figs. 5.19a–f and 5.20a–e)
				5.4.10.3	 Postoperative Care
		5.5	 Tips and Tricks
		5.6	 Results and Conclusions
		References
	6: Dorsal Inlay Tubularized Incised Plate (DTIP) Repair
		6.1	 Introduction
		6.2	 Indications
		6.3	 Video Demonstration
		6.4	 Steps of the Procedure
			6.4.1	 Penile Degloving
			6.4.2	 Preparation of Ventral Dartos Flap
			6.4.3	 Periurethral Plate Incision
			6.4.4	 Chordee Correction
			6.4.5	 Urethroplasty and Harvest of Inner Preputial Graft
			6.4.6	 Glanuloplasty
			6.4.7	 Skin Closure
		6.5	 Post-Operative Care
		6.6	 Tips and Tricks
		6.7	 Results and Conclusion
		References
	7: The Slit-Like Adjusted Mathieu (SLAM) Technique
		7.1	 Introduction
			7.1.1	 Evolution of the Mathieu/Flip Flap/SLAM Technique
		7.2	 Indications
		7.3	 Steps of the Procedure
		7.4	 Postoperative Care
		7.5	 Postoperative Care
		7.6	 Tips and Tricks
		7.7	 Results and Conclusion
		References
	8: The Glanular-Frenular Collar (GFC) Technique
		8.1	 Introduction
		8.2	 Indications
		8.3	 Steps of the Procedure (Fig. 8.1)
		8.4	 Tips and Tricks
		8.5	 Results and Conclusion
		References
	9: Glandular Urethral Disassembly (GUD) Technique
		9.1	 Introduction
		9.2	 Indications
		9.3	 Steps of the Procedure
		9.4	 Tips and Tricks
		9.5	 Results and Conclusion
		References
	10: Urethral Mobilization Procedure
		10.1	 Introduction
		10.2	 Indications
		10.3	 Steps of the Procedure
		10.4	 Postoperative Care
		10.5	 Tips and Tricks
		10.6	 Results and Conclusion
		References
Part III: Procedures for the Repair of Proximal Hypospadias
	11: Staged Preputial Graft (SPG) Repair
		11.1	 Introduction
		11.2	 Indications
		11.3	 Video Demonstration
		11.4	 Steps of the Procedure
			11.4.1	 First Stage
			11.4.2	 Second Stage
		11.5	 Post-Operative Care After the First Stage
		11.6	 Tips and Tricks
		11.7	 Outcomes
		References
	12: Byars Flaps for Staged Urethroplasty
		12.1	 Introduction
		12.2	 Indications
		12.3	 Video Demonstration
		12.4	 Steps of the Procedure
			12.4.1	 Anatomy Assessment, Penile Degloving
			12.4.2	 Artificial Erection
			12.4.3	 Ventral Corporotomy
			12.4.4	 Byars Flap Skin Closure
			12.4.5	 Second-Stage Repair
		12.5	 Postoperative Care
		12.6	 Tips and Tricks
		12.7	 Conclusions
		References
	13: Onlay Island Flap for the Repair of Hypospadias
		13.1	 Introduction
		13.2	 Indications
		13.3	 Steps of the Procedure
			13.3.1	 Patient Preparation
			13.3.2	 Marking Drawing
			13.3.3	 Penile Degloving and Orthoplasty
			13.3.4	 Harvesting Dorsal Preputial Island Flap
			13.3.5	 Preparation of the Glans
			13.3.6	 Suturing of the Flap
			13.3.7	 Second-Layer Coverage
			13.3.8	 Glansplasty
			13.3.9	 Wound Closure
		13.4	 Tips and Tricks
			13.4.1	 Patient Selection
			13.4.2	 Flap Design
			13.4.3	 Mobilization of the Onlay Island Flap
			13.4.4	 Suturing Technique
			13.4.5	 Postoperative Care
			13.4.6	 Surgeon Experience
		13.5	 Results
		13.6	 Conclusions
		References
	14: The Lateral-Based Onlay (LABO) Flap Technique for Proximal Hypospadias Without Severe Chordee
		14.1	 Introduction
		14.2	 Indications
		14.3	 Video Demonstration
		14.4	 Surgical Technique
		14.5	 Postoperative Care
		14.6	 Tips and Tricks
		14.7	 Results and Conclusion
		References
	15: Combined Buccal Mucosa Graft (Watch Shape) with Onlay Skin Flap for Severe Hypospadias: One-Stage Repair
		15.1	 Introduction
		15.2	 Indications
		15.3	 Video Demonstration
		15.4	 Steps of the Procedure
			15.4.1	 Suprapubic Catheter
			15.4.2	 Penile Degloving
			15.4.3	 Urethral Plate Dissection
			15.4.4	 Preparation of Longitudinal Dorsal Island Skin Flap
			15.4.5	 Buccal Mucosa Harvesting
		15.5	 Correction of Ventral Curvature with Simultaneous Urethral Plate Creation
			15.5.1	 Urethroplasty
			15.5.2	 Glansplasty
			15.5.3	 Penile Skin Reconstruction
		15.6	 Post-operative Care
		15.7	 Tips and Tricks
		15.8	 Results and Conclusion
		References
	16: Koyanagi Procedure
		16.1	 Introduction
		16.2	 Indications
		16.3	 Steps of the Procedure
			16.3.1	 Incision Lines
			16.3.2	 Mobilization of Tissues for Urethroplasty
			16.3.3	 Transfer of the Tissues to the Ventral Aspect of the Genital Tubercle and Positioning of the Neo-urethra
			16.3.4	 Urethral Plate Tubularization and Penile Skin Covering
		16.4	 Step-by-Step Video of the Procedure
			16.4.1	 Tips and Tricks
		16.5	 Results and Conclusion
		References
	17: Proximal Hypospadias, One-Stage Reconstruction, Double-Face Preputial Island Flap
		17.1	 Introduction
		17.2	 Steps of the Procedure
			17.2.1	 Preoperative Preparation
			17.2.2	 Peroperative and Postoperative Pain Management
			17.2.3	 Surgical Steps
			17.2.4	 Postoperative Care
		17.3	 Tips and Tricks
		17.4	 Results and Conclusions
		References
	18: Chordee Excision and Distal Urethroplasty (CEDU) for Perineal Hypospadias
		18.1	 Introduction
		18.2	 Patient’s Selection
		18.3	 Video Demonstration
			18.3.1	 Stage 1 Surgical Technique (Figs. 18.1, 18.2)
			18.3.2	 Stage II: Perineal (Proximal) Urethroplasty
		18.4	 Postoperative Care
		18.5	 Tips and Tricks
		18.6	 Results and Conclusions
		References
	19: Single-Stage Primary Proximal Hypospadias Repair with Penile Curvature Correction
		19.1	 Introduction
		19.2	 Indications
			19.2.1	 Penoscrotal Hypospadias
			19.2.2	 Severe Penile Curvature
			19.2.3	 Availability of Prepuce Tissue
		19.3	 Steps of the Procedure
			19.3.1	 Penile Degloving
			19.3.2	 Dissection of Spongiosa
			19.3.3	 Transection of Urethral Plate
			19.3.4	 Penile Curvature Correction
			19.3.5	 Urethroplasty
			19.3.6	 Skin Closure
		19.4	 Post-operative Care
		19.5	 Tips and Tricks
		19.6	 Results and Conclusion
		References
Part IV: Procedures to Correct Penile Curvature
	20: Penile Curvature Correction Using Dorsal Plication
		20.1	 Introduction
		20.2	 Indications
		20.3	 Surgical Technique
		20.4	 Tips and Tricks
		20.5	 Results and Outcomes
		References
	21: Deep Transverse Incisions of Tunica Albuginea (DTITA) Repair for Severe Ventral Penile Curvature
		21.1	 Introduction
		21.2	 Indications
		21.3	 Video Demonstration
		21.4	 Steps of the Procedure
		21.5	 Post-operative Care After the First Stage
		21.6	 Tips and Tricks
		21.7	 Outcomes
		References
	22: The Corporotomy and Dermal Graft Procedure: The Case for Severe Curvature
		22.1	 Introduction
		22.2	 Indications
		22.3	 Steps of the Procedure
		22.4	 Tips and Tricks
		22.5	 Results and Conclusion
		References
Part V: Surgical Harvest for Intervening Coverage Layers
	23: Harvest of Ventral Dartos Flap for Second Coverage of Urethroplasty
		23.1	 Introduction
		23.2	 Indication
		23.3	 Key Steps of the Procedure
		23.4	 Tips and Tricks
		23.5	 Outcomes
		References
	24: Dorsal Dartos Flap Covering of the Neourethra for Fistula Prevention in Hypospadias Repair
		24.1	 Introduction
		24.2	 Indications
		24.3	 Video Demonstration
		24.4	 Steps of the Procedure
			24.4.1	 Suprapubic Catheter
			24.4.2	 Penile Degloving
			24.4.3	 Preparation of Longitudinal Dorsal Dartos Flap
			24.4.4	 Urethroplasty
			24.4.5	 Fixation of the Dartos Flap
			24.4.6	 Glansplasty and Penile Skin Reconstruction
		24.5	 Post-operative Care
		24.6	 Tips and Tricks
		24.7	 Results and Conclusion
		References
	25: Harvest of Tunica Vaginalis Flap for Second Coverage of Urethroplasty
		25.1	 Introduction
		25.2	 Indications
		25.3	 Key Steps of the Procedure
		25.4	 Tips and Tricks
		25.5	 Outcomes
		References
Part VI: Harvest of Grafts from Non-preputial Sources
	26: Upper Lip Mucosal Graft for Hypospadias Cases
		26.1	 Introduction
		26.2	 Steps of the Procedure
		26.3	 Post-operative Care
		26.4	 Results and Outcomes
		References
	27: Buccal (Cheek) Mucosa Graft
		27.1	 Introduction
		27.2	 Preoperative Assessment and Preparation
		27.3	 Steps of the Procedure
		27.4	 Tips and Tricks
		27.5	 Postoperative Care
		27.6	 Results and Outcomes
		References
	28: Buccal (Lingual) Mucosa Graft
		28.1	 Introduction
		28.2	 Indications
		28.3	 Preoperative Preparation
		28.4	 Steps of the Procedure
		28.5	 Postoperative Care
		28.6	 Tips and Tricks
		28.7	 Results and Outcomes
		References
	29: Cutaneous; Retro-Auricular, Arm Grafts
		29.1	 Introduction
			29.1.1	 Retroauricular Wolfe Skin Grafts
			29.1.2	 Inner Upper Arm Skin Grafts
		29.2	 Indications
		29.3	 Video Demonstration
			29.3.1	 Full-Thickness Retroauricular Skin Graft (Fig. 29.1a, b)
			29.3.2	 Full-Thickness Skin Graft from the Inside of the Upper Arm (Fig. 29.2a, b)
		29.4	 Steps of the Procedure
			29.4.1	 Full-Thickness Retroauricular Skin Graft
				29.4.1.1	 Traction Sutures
				29.4.1.2	 Surgical Marking
				29.4.1.3	 Hydrodissection
				29.4.1.4	 Incision
				29.4.1.5	 Graft Harvest
				29.4.1.6	 Donor Site Wound Closure
				29.4.1.7	 Contralateral Retroauricular Skin Graft
				29.4.1.8	 Graft Preparation
				29.4.1.9	 Positioning the Graft
			29.4.2	 Full-Thickness Skin Graft from the Inside of the Arm
				29.4.2.1	 Surgical Marking
				29.4.2.2	 Incision
				29.4.2.3	 Hydrodissection
				29.4.2.4	 Graft Harvest
				29.4.2.5	 Hemostasis
				29.4.2.6	 Donor Site Wound Closure
				29.4.2.7	 Graft Preparation
				29.4.2.8	 Positioning the Graft
		29.5	 Post-operative Care
			29.5.1	 Full-Thickness Retroauricular Skin Graft
			29.5.2	 Full-Thickness Skin Graft from the Inside of the Arm
		29.6	 Tips and Tricks
		29.7	 Results and Conclusion
		References
	30: Bladder Mucosa Graft
		30.1	 Introduction and Indications
		30.2	 Steps of Surgery
			30.2.1	 First Surgical Procedure
			30.2.2	 Bladder Mucosa Graft Harvesting by Minimal Detrusotomy
			30.2.3	 Tubularization of the Graft
			30.2.4	 Tunneling of the Graft (Fig. 30.5)
		30.3	 Results
		30.4	 Discussion
		References
Part VII: Management of Post Hypospadias Repair Common Complications
	31: Repair of Subcoronal Fistula in Cases of Well-Healed Glans without Compromising the Glans
		31.1	 Introduction
		31.2	 Video Demonstration
		31.3	 Steps of the Procedure
			31.3.1	 Marking of Fistula and Adjacent Dartos-Skin Flap
			31.3.2	 Superficial Dissection of Fistula
			31.3.3	 Preparation of Adjacent Dartos-Cutaneous Flap
			31.3.4	 Deep Freeing of the Fistula
			31.3.5	 Fistula Closure
			31.3.6	 Inter-positioning of Vascular Flap
			31.3.7	 Skin Cover
			31.3.8	 Post-operative Care
		31.4	 Results and Conclusion
		References
	32: Management of Post-Hypospadias Repair Urethrocutaneous Fistula
		32.1	 Introduction
		32.2	 Video Demonstration
		32.3	 Steps of Procedure
			32.3.1	 Depending on Size of Fistula
				32.3.1.1	 For Fistula Larger than 5 mm
				32.3.1.2	 For Small Fistulas Less than 5 mm Width (Inversion Technique)
			32.3.2	 Depending on the Presence and Location Stricture
				32.3.2.1	 If There Is Distal Glanular or Meatal Stenosis
				32.3.2.2	 If the Stricture Is Only Focal at Site of Fistula
			32.3.3	 Multiple Fistula
		32.4	 Results and Conclusion
		References
	33: Approach to Redo Surgery for Failed TIP Urethroplasty
		33.1	 Introduction
		33.2	 Steps of the Procedure
			33.2.1	 Scenario 1
			33.2.2	 Scenario 2
		33.3	 Video Demonstration
		33.4	 Tips and Tricks
		33.5	 Conclusions
		References
	34: Management of Penile Stricture After Hypospadias Repair
		34.1	 Introduction
		34.2	 Indications
		34.3	 Video Demonstration
		34.4	 Steps of the Procedure
			34.4.1	 Approach 1 (Ventral Urethrotomy)
			34.4.2	 Approach 2 (Dorsal Inlay BMG Urethroplasty)
			34.4.3	 Approach 3
		34.5	 Post-operative Care
		34.6	 Tips and Tricks
		34.7	 Results and Conclusion
		References
	35: Cecil Culp Procedure
		35.1	 Introduction
		35.2	 Indications
			35.2.1	 Redo Hypospadias Repair
			35.2.2	 Non-Hypospadias Repair (Trauma)
		35.3	 Video Presentation
		35.4	 Steps of the Procedure
			35.4.1	 Penile and Urethroplasty Reconstruction
			35.4.2	 Scrotal Incision
			35.4.3	 Embedding Penis into Scrotum
			35.4.4	 Release of Penis
		35.5	 Postoperative Care
		35.6	 Tips and Tricks
		35.7	 Conclusion
		References
Part VIII: Miscellaneous Procedures
	36: Foreskin Reconstruction in Hypospadias Cases
		36.1	 Introduction
		36.2	 Indications
		36.3	 Steps of the Procedure
		36.4	 Tips and Tricks
		36.5	 Results and Conclusion
		References
	37: Preputioplasty in Hypospadias Surgery
		37.1	 Introduction
		37.2	 Indications
		37.3	 Contraindications
		37.4	 Steps of the Procedure
		37.5	 Tips and Tricks
			37.5.1	 Retractability at the End of Procedure
			37.5.2	 Dorsal Preputial Release Incision (DPRI)
			37.5.3	 Pan’s Modification
			37.5.4	 Securing the Catheter at the End of Surgery
			37.5.5	 Defining Postoperative Phimosis
		37.6	 Results and Conclusion
		References
	38: Correction of Penoscrotal Transposition
		38.1	 Introduction
		38.2	 Video Demonstration
		38.3	 Steps of the Procedure
			38.3.1	 Preparation of Flap
			38.3.2	 Reforming the Suspensory Ligament
				38.3.2.1	 Scrotoplasty
		38.4	 Post-operative Care
		38.5	 Tips and Tricks
		38.6	 Results and Conclusion
		References
	39: Tips and Tricks in Post-hypospadias Repair Dressing
		39.1	 Introduction
		39.2	 Indications
		39.3	 Video Demonstrations
		39.4	 Steps of the Procedure
		39.5	 Tips and Tricks
		39.6	 Results and Conclusion
		References