Hypospadias: results of treatment in 18 years of paediatric surgical practice.

This is a review of hypospadias surgery in a provincial surgical practice over 18 years. A total of 347 boys were seen with hypospadias, of whom 209 were operated upon. These operations consisted of 69 Durham Smith de-epithelialized double-breasting two-stage procedures, 45 meatal advancement and glanuloplasty procedures, 27 hemi-circumcisions with or without meatotomy, 24 single stage repairs for distal hypospadias without chordee, 23 operations for chordee without hypospadias, 15 modified Mathieu single stage procedures and six miscellaneous procedures. The complication rate, particularly for fistulae formation in 17%, was unacceptably high. Some causes of fistulae were identified; these included delayed absorption of chromic catgut sutures and stitch abscess. Stricture occurred less frequently, but one case was severe enough to require complete revision of the urethroplasty. In early operations a coronal meatus was the norm and six patients required advancement procedures.