Hypospadias, a common congenital deformity, is the result of incomplete formation of the urethra during the 10th- to 14th weeks of gestational life. Surgery to repair the foreshortened urethra and penile curvature in hypospadias has a history of more than 150 years. To date, more than 300 surgical procedures with accompanying variations have been proposed for the repair of hypospadias. With modern techniques of tissue transfer, even the most severe case of hypospadias is amenable to repair. The modern era of hypospadias surgery has allowed the application of skin grafts and flap techniques to add significantly to urethral length. At the same time, a variety of new techniques have been proposed to "minimize" hypospadias surgery. In this article the authors argue that for the worst cases of hypospadias, complete dissection of the abnormal anatomy and modern tissue transfer techniques should be used to reconstruct the deformity.
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