Masculinizing Genital Surgery

It is important to differentiate between hypospadias and disorders of Sexual development and it is very unfair for many children with simple straight forward distal, midpenile, or even proximal hypospadias with normal descended testes to be put under the same category as patients with unclear gender differentiation. Once it is decided that the baby is a boy, it is important to proceed with surgery as early as 6 months of age to try to avoid corporeal disproportion. Ideally, the masculinizing surgery should be carried out in a well-planned staged procedure including bringing the testes into the scrotum, correction of severe chordee by excision of the hypoplastic urethral plate as well as the outer longitudinal layer of tunica albuginea (Tunica Albuginea longitudinal excision or TALE procedure) with or without corporotomy and grafting. Dorsal plication has a very high rate of complications and recurrence of chordee. The next step is to bring down healthy skin (Two-Stage Bilateral Based Flap (BILAB), Chordee Excision and Distal Urethroplasty, CEDU procedure), two-stage Byars flaps or healthy skin, prepuce or buccal mucosal graft (Cloutier or Bracka graft).