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Prof. Dr. Ali Avanoğlu
Hypospadias Surgery • Surgery in Children

Complex Hypospadias Repair

Two separate problems overlap in this picture: the penis isn't straight, and the foundation for building the new channel isn't adequate. When both are forced into a single session, the suture line stays under tension.

Who this is forCurvature combined with tissue shortage
Reading≈1 min
ByProf. Dr. Ali AvanoğluUpdated
This page is part of hypospadias surgery.Read the full treatment overview on the hub page
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side view
In brief3 madde
  • Two problems combined: Curvature alone is a solvable problem; an inadequate plate alone can be overcome with a graft.
  • Planning steps: Curvature is measured with an artificial erection test and remeasured after correction.
  • What should be explained to the family?: In this group, an additional corrective procedure is not an unusual failure — it is an expected part of the process.
01

Two problems combined

Curvature alone is a solvable problem; an inadequate plate alone can be overcome with a graft. Together, the difficulty compounds, because the procedure used to correct curvature makes the plate even less adequate.

  • That's why the order is: fully correct the curvature, prepare the foundation by adding tissue, and allow time for it to heal. The channel is only built once a solid foundation has formed.
02

Planning steps

  • Curvature is measured with an artificial erection test and remeasured after correction.
  • The flexibility and width of the plate are assessed; an unhealthy plate is not preserved, it is removed.
  • An inventory of usable tissue is taken: is the foreskin still available, is oral mucosa needed.
  • Pre-operative testosterone treatment is planned if needed.
03

What should be explained to the family?

In this group, an additional corrective procedure is not an unusual failure — it is an expected part of the process. Setting expectations accordingly makes the process much easier to go through.

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Frequently asked questions
Is this the most difficult group?
Among primary cases, it is the most challenging. Even so, a properly planned staged repair achieves good results; patience and experience are what matter most.
Which tissue will be used?
If the foreskin is still available, it's the first choice. If not, or if it's inadequate, oral mucosa is used — this tissue tolerates a moist environment well and holds up reliably.
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