ABSTRACT
Hypospadias repair involves penile straightening (orthoplasty), urethroplasty, and subcutaneous and skin coverage. Patients with severe hypospadias, including patients with ambiguous genitalia assigned a male gender, present particular challenges in all these aspects. More complex cases tend to have more significant chordee and a smaller phallus. The urethral defect is by definition more severe and the urethral plate tissue is generally less robust. The small rounded glans with minimal cleft typical of these cases also makes a urethroplasty more challenging for these patients. Finally, the limited amount of penile skin limits the reconstructive options. Certain aspects of the repair in any given patient may be accomplished with the same approaches utilized for more distal forms of hypospadias, but generally more aggressive techniques are required for the severe cases.
