An analysis of different techniques for distal hypospadias repair: the price of perfection.

We discuss the risks of total surgical correction of distal hypospadias with chordee, review 42 such cases and analyze 4 common surgical procedures that were used. The over-all complication rate was 16.6 per cent (7 of 42), with 9.5 per cent (4 of 42) of the cases requiring addition urethral reconstruction. All complications occurred following procedures designed to extend the urethral meatus to the tip of the glans (Horton-Devine 5 of 15 and Ombrédanne 2 of 8). In contrast, no complications occurred following urethral advancement or Allen-Spence repairs (0 of 19). The physician and family should be aware of the increased risk attendant with total anatomical urethral correction in contrast to less extensive surgery, which gives an excellent functional result with minimal risk.