Dr Sagar Jawale's Urethral Pull Up Operation

Title: Urethral pull up operation for distal and mid penile hypospadias Aims and objectives: To invent a better operation for distal and mid penile hypospadias. Methods and Material: Last 30 months I operated 51 cases of hypospadias with the urethral pull up operation. Age range was 11 months to 17 years. Glanular hypospadias cases were excluded. Coronal Hypospadias was found in 23(45%), Subcoronal Hypospadias was found in 26(51%) and Mid Penile Hypospadias in 2(4%) patients. 40(78.5%) out of 51 patients had chordee. The technique: The urethra along with the corpus spongiosum is dissected off the corpus cavernosum up to penoscrotal juction. The urethral tube is stretchable and can easily pulled beyond the tip of glans penis. The urethral tube bleeds profusely till the tip on releasing tourniquet is the proof of its vascularity. The distal 5 mm stenotic and avascular part of urethral tube is excised. The urethra stitched to the neo meatus by 6 stitches. The urethra hitched to the buck's fascia at glanular, subcoronal and mid penile level by interrupted sutures of 5-0 vicryl one on either side. Total penile skin rotated all around the penis and sutured to the glans penis. Results: Meatal regression in one patient (2%), two subcutaneous hematomas (4%) and two wound gapes (4%). No patient developed fistula, meatal stenosis and residual chordee. Normal UFR and good to excellent cosmetic appearance at the end of three months. Discussion: The operation is "Fistula Proof" as the mucosal integrity of urethra is not breached. Radical correction of penile chordee is possible in a single stage. Byar's skin flaps can be done without violation of basic principles of surgery. operation where there is patient's own God given urethral mucosa right at the tip of the penis forming the best urethra and neo meatus instead of preputial skin, fibrous tissue, buccal mucosa or split skin graft as in other operations. The operation does not require doing a Dartos flap and a suprapubic diversion. Fastest operation which completes in just 30 minutes. Conclusions: In my series the urethral plate was found to be responsible for chordee in 77 % cases. Hence the focus should naturally shift away from urethral plate conserving operations to the urethral pull up operation as it is fistula proof, more physiological, quick to perform and does not require suprapubic diversion and a Dartos flap. Key-words: Distal Hypospadias, mid Penile hypospadias, Urethral pull up operation, Modified technique for hypospadias surgery, Snodgrass Repair