Modified ASOPA procedure (Hodgson XX) achieves the goals of hypospadias repair

Several vascularized island flap procedures have been described for the repair of severe hypospadias with chordee. The modified ASOPA (Hodgson XX) procedure, a variant of transverse island flap, employs an inner preputial skin tube for the neourethra while providing simultaneous skin coverage. Since 1989, more than 240 hypospadias repairs have been performed at the authors' institution, including 15 modified ASOPA procedures. All of the patients had proximal hypoapadias with chordee. The follow-up of 12 of these patients showed a straight penis, free of chordee, with the meatus at the tip in 11 (92%). One patient had glanular separation and retraction of the meatus to a coronal position. No patient had a urethrocutaneous fistula or urethral diverticulum. Proximal anastomotic strictures were identified in three (25%) patients, which resolved with dilation in two and with internal urethrotomy in the other. The final cosmetic appearance was excellent for 11 patients. Based on these results, the authors conclude that the modified ASOPA procedure reliably achieves the goals of hypospadias repair: release of chordee, urethroplasty, scrotoplasty, and redistribution of skin coverage in one operation, with minimal morbidity.