3.3.1 Complications

Whereas meatal narrowing after splint removal can be corrected by careful stretching and the Dittel device, operative revision is needed in cases of a scarred meatus as slitting and stretching are ineffective in the long term. In urethral stricture, open surgery should be performed after one attempt at internal urethrotomy. With fistulae, revision should not be planned before a lapse of 6 months. Urethral stricture should be excluded intra-operatively as a cause of the fistula. To prevent the recurrent fistula formation, a dartos flap or a free tunica vaginalis patch may be used. Attention should be paid to adequate subsequent cover with mobilized Scarpa's fasciae.

Correction of a minor residual curvature, sometimes reported by the parents, should be discouraged, as it has no functional relevance. It can be easily corrected after puberty, if significant.

Table 2: Algorithm for the management of hypospadia

Hypospadia

Reconstructionrequired

Preparation

(foreskin, hormone therapy)

Distal

Proximal

Chordee

No Chordee

Urethral plate cut

Urethral plate preserved

MAGPI, Mathieu, King, Duplay, Snodgrass etc.