Therapy 2 (Hypospadias)

geni_36a_n.jpg and geni_36b_n.jpg: Two steps of a urethral reconstruction in an intermediate type of hypospadias. geni_36a_n.jpg: The tip of the glans is elevated by a stay-suture; the internal sheath of the prepuce is stretched by two sutures at the edges; needle in the corpus cavernosus of one side; white tube in the proximal urethra which has been excised from its ectopic orifice. After longitudinal incision at the ventral side of the distal penis shaft and excision of the orifice, the skin is detached from the sulcus and from the surface of the penis. The demonstrated patch of the internal preputial sheath is detached with a preserved stalk of vessels, formed into a tube, displaced ventrally, and anastomosed with the proximal urethra as distal part of the new urethra. Prior to the described proceeding, the curvature of the penis has been relieved by excision of the scarred cord between the corpora cavernosa; the artifical erection shown in the picture serves as proof and quantification of a curvature of the penis before and after stretching of the penis. geni_36b_n.jpg: The glans and the penis are swollen and straight. The findings are analogous to a total circumcision. The curvature of the penis is relieved. Visible is a reconstructed urethra which reaches the middle of the glans and is covered by penile skin.