During the hypospadias repair second stage, it will be done approximately 6 months later, urethroplasty was accomplished with the help of graft tubulization. Graft take is usually excellent, with only some cases requiring an added inlay patch at 2nd stage due to graft contracture. A staged method allows excellent cosmetic results & less morbidity.
PROCEDURE:
-
The second stage, consists of the tubularization of the graft, is usually planned after 6 months.
-
In this gap, graft shrinkage can occur in almost 20% of cases. This must indeed be taken into consideration while harvesting. If too much shrinkage occurs in between procedures. The graft will be re-augmented in the second stage by insertion a fresh free graft as in-lay after centerline hinging.
-
Glansplasty is generally easily to perform and allows for a deep insertion of the neo-meatus and formation of a slit-like meatus. Additional waterproofing layers are suggested whenever it is possible.
-
In difficult redo cases, a tunica vaginalis flap is usually the only probable site to mobilize such an additional layer.
-
Skin coverage must ideally be done by midline approximation of the skin with the help of sub-epithelial interrupted stitches. Skin coverage can yet be sometimes relatively difficult and may involve fantasy.
-
After this stage we generally leave a indwelling supra-pubic diversion and trans-urethral catheter. The former is detached after 7 days, while the latter after one more week during which it is kept blocked, if no problems occurs.
