Hipospadia

Tujuan pembedahan
Usaha: fungsional dan kosmetik senormal mungkin
Meatus lebih dekat glans bisa BAK berdiri
Eksisi/ release chordee normal intercourse
Penampilan phallus penis normal yg disunat
Operasi bisa satu atau beberapa tahap
Umur sekolah diharapkan sudah selesai

Hipospadia
Hasil yang ideal:
- penis tampak normal
- meatus terletak pada tip glans
- Bisa BAK berdiri
- Penis lurus saat ereksi

Hipospadia
Pilihan prosedur pembedahan tergantung:
1. Chordee
2. Lokasi dan ukuran meatus
3. Banyaknya kulit dorsal penis
4. Urethral plate

Urethral plate
Vaskularisasi baik, lentur, dapat sembuh
tanpa jaringan parut
Tidak ada jar fibrotik atau displastik
Preservasi urethral plate mengurangi
komplikasi pembedahan
Dapat ditubularisasi primer (Tubularized
Incised Plate / TIP) tanpa perlu tambahan
flap kulit

Management of hypospadias in Jakarta

Androgen stimulation
Testosteron enanthate 25 mg im monthly
months pre-op
HCG 250 IU
- twice a week for 5 weeks
(Koff & Jayanthi, J Urol 1999; 162: 1435)

demonstrated growth of proximal shaft,

chordee improvement, improved results

Hipospadia
Aspek bedah standard
-

pakai pembesaran optik (loupe 3.5X)

General, regional, caudal anesthesia
Instrument opthalmic
Benang 6-0 absorbable (catgut, chromic, vicryl,
Dexon, PDS)
- Silastic tubes dengan atau tanpa diversi urin
- Penile dressing lebih simple (Op-Site)
- Antibiotika perioperatif

Hipospadia
Timing operasi:
umur terbaik: 6 bulan 12 bulan

Hipospadia
Terdpt > 200 prosedur pembedahan
Yg ideal?
keputusan teknik pembedahan sangat tergantung
operator, kadang-kadang diputuskan di meja operasi
Konsep umum pembedahan
Complete correction of any ventral penile chordee
harus dikerjakan sebelum urethroplasty

Hipospadia
Prinsip-prinsip dasar operasi hipospadia
1. Chordectomi / orthoplasty
2. Urethroplasty
3. Meatoplasty
4. Glanuloplasty
5. Skin coverage

Management of hypospadias in Jakarta

Treatment of anterior
hypospadias
The MAGPI technique
Mathieu or perimeatal based flap procedure
Tubularized Incised Plate (TIP)
urethroplasty

Management of hypospadias in Jakarta

Treatment of posterior
hypospadias
Tubularized Incised Plate (TIP)
urethroplasty
Onlay island flap repair
Transverse Tubularized Island Flap
Two stage

Meatoplasty and Glanuloplasty (MAGPI)

Tubularized Incised Plate (TIP)

Tubularized Incised Plate (TIP)

Perimeatal-based flap (Mathieu technique)

Perimeatal-based flap (Mathieu technique)

Onlay island flap repair

Onlay island flap repair

Transverse Preputial Island Flap Repair

Transverse Preputial Island Flap Repair

Two-stage hypospadias repair

Two-stage hypospadias repair

Management of hypospadias in Jakarta

Results

Jan 2002 Des 2003

26 Pts
Mean age year 4,9 (SD 3,4)
Mean surgery time (min): 110,5 (SD 25,1) TIP procedure
Complications
Hypospadias
Location

Repair
Techniques

No.
Pts

Metal
Stenosis

Fistula
(Pin Point)

Middle
Proximal

TIP
TIP
Onlay
2 Stage

15
6
3
2

0
1
0
0

5 (33%)
3 (50%)
0
0

Urol Clin N Am 29 (2002) 285-290

Tubularized Incised Plate (TIP) Urethroplasty