Thiersch-Duplay Principle
In 1869, Professor C. Thiersch reported that in 1857 and 1858 he had tubularized the urethral plate to form a urethral canal in a child born with epispadias. He credited the technique to August Brauser, his onetime assistant. Thiersch’s classic article il
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Introduction
In 1869, Professor C. Thiersch reported that in 1857 and 1858he had tubularized the urethral plate to form a urethral canal in a child born with epispadias . He credited the technique to August Brauser, his onetime assistant . Thiersch's classie article illustrated the design of the flaps and the asymmetrie lateral incisions so that the urethral suture lines are unopposed. In 1874, Duplay described the tubularization of the urethral plate distal to the urethral orifice. His first successful hypospadias repair with this technique was achieved in five stages. In 1880, Duplay observed the capacity of the urethral plate to tubularize over a catheter. He wrote: "Although the catheter is not actually covered entirely by skin, I am convinced that this has no ill effect on the formation of the new urethra; stricture formation does not occur so long as half of the urethral wall is supplied by skin". This concept was popularized by Denis Browne in 1949, when he described the buried skin strip method for hypospadias repair. Mettauer first reported the concept of skin chordee in 1842, and subsequently D.R. Smith reported it in 1967. In 1968Allen and Spence utilized the technique of degloving the penile skin and performed foreskin transposition to correct coronal hypospadias with moderate to severe chordee. King (1970) incorporated the concepts of Mettauer and Thiersch-Duplay to correct midshaft hypospadias and brought the meatus to the coronal sulcus. In early years glanular and subcoronal hypospadias were often not repaired, because the complications of repair often overshadowed the benefits of surgieal correction. Duckett's (1981) meatal advancement and glanuloplasty technique (MAGPI) was designed to reduce the risks of formal urethroplasty in distal hypospadias. Time and experience demonstrated that this technique could not be universally applied to all patients with distal hypospadias. Arap et al. (1984) modified the MAGPI technique to repair a more proximal meatus. Decter (1991) described the
A. T. Hadidi et al. (eds.), Hypospadias Surgery © Springer-Verlag Berlin Heidelberg 2004
13 technique of an "M inverted V" glanuloplasty and utilized the Mathieu (1932) principle. Both Arap's and Decter's methods were designed to reduce the chance of meatal retraction, which is sometimes seen after conventional MAGPI repair, and to improve the cosmetie result of the glans penis. However, neither achieved wide acceptance. Zaontz, in 1989, applied the Thiersch-Duplayprinciple to the repair of distal hypospadias. He reported excellent results with the glans approximation procedure (GAP).The operation was indicated for patients with coronal or glanular hypospadias, deep glanular groove and a fish-mouth meatus. The GAP eliminat ed the ventral glanular tilt, meatal retraction and splaying of the urinary stream that was seen at times in meatal advancement and glanuloplasty procedures. Van Horn and Kass (1995) modified King's (1970) approach by extending the paraurethral incision to the tip of the glans penis and used a two l
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