Midshaft (Mid-Shaft) Hypospadias Surgery

The channel built in this group is noticeably longer than in distal cases. As the channel gets longer, the area that needs monitoring for both fistula and stricture grows — this is why the protective tissue layer covering the new channel is more critical here than in distal repairs.

• On the other hand, if curvature is minimal and the groove is usable, the channel can be built on the existing plate and the repair completed in a single session.

• TIP (Snodgrass) repair — applicable in most midshaft cases.
• Graft-augmented TIP (Snodgraft) — if the plate is narrow, it is widened with a small patch taken from the foreskin or oral mucosa.
• Onlay island flap — a flap prepared from the foreskin is placed over the plate to complete the channel.
• Double-layer dartos covering — in longer channel repairs, the protective layer is planned as two layers instead of one.

Go in knowing the final decision is made during surgery. If the plate turns out thinner than expected once the skin is opened, or if curvature exceeds 30 degrees on the artificial erection test, the surgeon may switch to a staged plan. Both possibilities should be discussed during the consent process.

• Surgery takes 2–3 hours, usually with one night in hospital.
• The catheter stays in for 7–10 days.
• Swelling and bruising are more pronounced than in distal repairs; they subside over 3–4 weeks.
• Stream quality and the width of the opening are assessed at the 3-month mark.