Chordee without Hypospadias Components Steps OR Set-up 1. Confirm meatus position, that hypospadias is not present Gauze sponge 2. Crede to confirm urinary stream is axially directed Towel 3. Evaluate for concealment. 1. Strategy Snugger 4. Artificial erection induced PRN “Grandfather ”

1. Robot set-up Robot clamp 2. Safely position glans traction to avoid hitting the 2. Robot setup boy’s head or dislodging ET tube Robot Arm 3. Suture taut, but not tight Marking pen 1. Midline scrotal incision 3. Complex scrotoplasy 2. Paired base incision as saw tooth Straight serrated scissors Grandfather forceps Marking pen 4. Reconstruct 1. Normalize preputial meatus 7x7-0 Vicryl (TG 140-8) [J546] - one appearance of skin 2. Rearrange foreskin to approach normal needle cut off “Father” forceps Straight serrated scissors 5-0 Ethibond (RB –1) [X 870] 1. Walk needle from dorsal meatus into lumen 5. Glans suture Straight hemostat 2. Exit needle1/3 of width of glans Marking pen “Baby” forceps 1. Crede to assess if urinary stream shows a normal direction Scalpel 2. Expose urethral web skin as “goal posts” Wreck-cel 3. Make urethrotomy incision between the “goal posts” Saline irrigation 6. Urethrotomy 4. Rechecks stream by crede after urethrotomy is complete 7-0 Vicryl (TG 140 - 8)[J546] -one needle cut off Curved Wescott scissors Assorted Straight Straight hemostat 1. Advance urethra to peno-scrotal junction “Fathers” foceps 7. Catheterize urethra 2. Check how thin the urethra is 5-0 Ethibond (RB –1) [X 870] 3. Suture ligate catheter to glans traction suture 8 French Red Rubber 5 French Feeding Tube CEVL 2009 Chordee without Hypospadias Components Steps OR Set-up

1. Circumcise and release chordee Skin Marker 8. Circumcise & 2. Chordee based on fibrous paraurethral tissue Straight serrated scissors release chordee 3. Cut to release/free glans wings and base of preputial flaps 4. Release snugger to obtain access to scrotum “Fathers” forceps Bovie

Bovie 1. Release dartos from peno-scrotal urethra “Fathers” forceps 9. Simple scrotoplasty 2. Midline scrotal dartos incision Senn 3. “Y” incision to permit scrotal halves to drop away 4x4 gauze Wescott scissors Straight serrated scissors

Single arm 6-0 PDS (BV-1) [PDP 117] – on cutting needle ?? 10. Approximate 1. Apprixmate Glans spongiosum in two layers if possible 6-0 PDS (S-28) [D 9125] ??? glans wings 2. Anchor glans inner preputial skin flaps to shaft “Fathers” forceps Wescott scissors 7-0 Vircyl (TG140 - 8)[J546] -one needle cut off Straight serrated scissors 1. Resurface proximal shaft “Fathers” forceps 2. Resurface distal shaft Bovie 11. Resurface ventrum 3. Circumcise outer foreskin 4x4 gauze 4. Thin dartos on dorsum Wescott scissors 5-0 chromic (P-3) [687] or use 5. Thin dartos on ventrum 7-0 Vircyl (TG 140 - 8) [J546] – 6. Close circumcision if penis small

1. Clean blood Mastisol 2. Dressing types & materials Xeroform gauze 3. Secure & wrap penis Excelon gauze?? 12. Crede & dressing 4. Check stream Tegaderm 5. Remove catheter Coban 6. Crede Blue towel 7. Remove glans traction suture & place bacitracin Grandmother Tissue Forcep

Straight  CEVL 2009