This document summarizes the author's 15 years of experience performing hypospadias surgery. It describes their early training focusing on distal repairs using techniques like Duplay and TIP. Over time, the author gained experience with more complex staged procedures for proximal hypospadias. Through workshops and online courses, the author was introduced to the Snodgrass technique and began evaluating patient anatomy more thoroughly. While attempting to replicate Snodgrass' approach, the author still encountered problems like fistulae. They developed preferences for single-stage repairs using TPOIF or staged repairs using STAG flaps. The author emphasizes the importance of anatomy, curvature, and glans development in achieving optimal outcomes.

1. Hypospadias Surgery
Evolution of Personal Experience in 15 Years
Mohamed Youssif, MD
Professor of Urology
Chief, Pediatric Urology
University of Alexandria
mohamed.youssif@alexmed.edu.eg
Cell phone: +201223429324

2. How it started
• Nationwide children hospital, Columbus Ohio 2007
• Distal
• Duplay, TIP
• Koff mobilization
• Barcat technique
• Proximal
• Staged Bayer`s flap
• Koyanagi
• Duckett
The passion and dedication to perfection is a KEY

3. Then came a long the spider
• Snodgrass workshop in Turkey
• Online workshop from Texas 2013, 2014
• Alexandria pediatric surgery workshop 2 times

4. Snodgrass revolutionized our hypospadias care
• Evaluation
• Anatomy
• Normal
• Usual hypospadias
• Unusual hypospadias
• MIP
• Hypospadias without hypospadias
• Glans size
• Data registry

8. Severity
Distal Proximal

9. Hypospadias variant
Megameatus intact prepuce Hypoplastic urethra

10. Instruments, sutures materials(needle
properties) and tissue handling

11. I did everything exactly like him
• But I still have problems
• With TIP (he insists that it works with every urethral plate)
• Meatal stenosis
• Fistulae
• With 2 stages preputial graft STAG
• Graft contracture
• Fistulae
• Glans dehiscence
• Skin issues
Outcome is NOT REPRODUCIBLE

12. Stage I: READ what others say
Stage II: REPEAT what others say
Stage III: QUESTION what others say

13. Distal hypospadias repair TIP

14. Not satisfied with mid to long-term outcome
Good
Bad

16. TIP in an adolescent

17. Proximal one stage repair TIP
DO NOT DO IT
IT IS ALL ABOUT CURVATURE

18. Urethrocutaneous fistula

19. Proximal one stage repair TPOIF
IT IS ALL ABOUT CURVATURE

20. Proximal one stage repair TPOIF
with dorsal plication
IT IS ALL ABOUT CURVATURE
but Glans aesthetics ??

21. Now, I only
incise

22. Proximal 2 stages repair STAG

23. Difficult time at the second stage repair

24. Sometimes you need to Redo the first stage

25. Topographic closure in Hypospadias
• Only incise when there is a
transverse ridge
• Develop glans wings adequately
• Single layer watertight interrupted
closure with spongioplasty
• Second layer waterproofing layer

27. Corpus spongiosum division in DPH

33. For proximal hypospadias

34. My new ???
Favorite
STAGED
Bayers flap