History of Hypospadias

Abstract

The evolution of hypospadias surgery can be classified under three periods that were closely related to advances in surgical instruments, introduction of anesthesia, and newer suture materials. Stretching dominated the early period, tunneling during the Middle Ages, and flaps during the modern period. Suture materials have included at various time silver wires, horsehair, and stainless steel.

Examination and translation of the original manuscripts showed that Galen recommended stretching and glue or suturing of glanular hypospadias and not amputation or partial penectomy as has been currently reported. The term chordee was first introduced in the eighteenth century in relation to gonorrhea and was defined as “painful imperfect erection of the penis during gonorrhoea, with downward incurvation.” This was a common complication of gonorrhea before the introduction of antibiotics. Mettauer, Duplay, Mayo, and others used the terms incurvation, ventral deformity, ventral curvature, and others. Clinton Smith in 1938 was the first surgeon to use the term congenital chordee in direct relation to hypospadias.

The use of prepuce for urethroplasty, popular now, was first reported by Liston in 1838, Rochet in 1899, Russell in 1900, and Mayo in 1901. The two-stage repair performed in the early twentieth century differed from that in the early twenty-first century in that urethroplasty was performed in the first stage and only anastomosis to the original meatus was performed in the second stage. The two-stage repair, currently known as Bracka’s two-stage repair, was first described in 1962 by Cloutier.

The use of the urethral plate in epispadias was first described by Liston in 1838, then Thiersch in 1869, and Anger and Duplay in hypospadias in 1874. Partially epithelialized urethroplasty using the urethral plate was described by Duplay in 1880, Russell in 1915, Browne in 1949, Reddy in 1975, Orkiszewski in 1987, Rich in 1989, and Snodgrass in 1994.