History of hypospadias: Lost in translation.

The evolution of hypospadias surgery can be classified under 3 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 suturing of glanular hypospadias and not amputation or partial penectomy as has been currently reported. The term chordee was first introduced in the 18th century in relation to gonorrhea and was defined as "painful imperfect erection of the penis during gonorrhea, 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 20th century differed from that in the early 21st 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, Thiersch in 1869 and by Anger & Duplay in hypospadias in 1874. Partially epithelialized urethroplasty using the urethral plate was described by Duplay in 1880, Russell 1915, Denis Browne 1940, Reddy 1975, Orkiszewski 1987, Rich 1989, and Snodgrass in 1994. LEVEL OF EVIDENCE: V.

[Hypospadia and infertility of Henry II of France (1519-1559)]. / Die Hypospadie und Infertilität von Heinrich II von Frankreich (1519-1559).

Henry II (1519-1559) of France was the second son of Francis I (1494-1547) and Claude de France (1498-1524) born in 1519 in St. Germain-en-Laye. After his older brother's and his father's death in 1547, he was anointed the French king in Reims. In 1533 already, as a 14-year-old boy, for reasons of state, he was married to the same aged Catherine de Medici (1519-1589), as her uncle was Pope Clement VII (1478-1534). The marriage remained childless for 11 years since Henry, due to a distinct hypospadia and a completely sexually inexperienced wife was unable to conceive children with her. His existing liaison to Diane de Poitiers (1499-1566) - a 19-year-older maid of honor of his father Francis I from 1537 until his death - influenced his sexual life immensely.The blame for the childless marriage was placed primarily on his wife, as Henry had become father of an illegitimate daughter with a mistress. Catherine then underwent all possible medical and alchemical procedures to finally give birth to the hoped Dauphin. Ironically, her rival for the favor of her husband, Diane de Poitiers was one of her greatest allies. She made clear that the cause lay with Henry and not with his wife. This was confirmed by the added solid physician Jean Fernel (1497-1558). His treatment of Henry and the simultaneous training of the unexperienced Catherine by Diane de Poitiers led to success.The result was the birth of Francis II (1544-1560) in 1544, the first of 10 children in 12 years. Thus, the dynasty was saved. After the death of Henry in a tragic tournament accident in 1559, three of his sons became kings of France. But the line of Valois remained without further descendants and was continued by Henry IV, the first Bourbon king in 1589.

Early hypospadias repair: the contributions of Harvey Cushing.

PURPOSE: The early evolution of surgical reconstructive techniques has been well documented in the literature. However, a review of the Johns Hopkins hospital surgical files revealed an interesting participant in early hypospadias repair: Harvey Cushing (1869-1939). METHODS: Following IRB approval, we reviewed the surgical records from 1896 to 1912 and selected from among his non-neurosurgical patients, one case of first-stage hypospadias repair. RESULTS: Cushing operated upon the 21-year-old patient, performing a first-stage repair of hypospadias, in conjunction with a repair of a right inguinal hernia. The patient was discharged following a second stage operation. At that time, the patient was in good condition and was voiding appropriately. There was no further follow-up. CONCLUSION: The repair of hypospadias evolved through the work of European surgeons, from the mid-eighth century through the early nineteenth century. The case we report here illustrates Cushing's early work in the fields of urologic and plastic surgery.

Sir Denis Browne: contributions to pediatric urology.

PURPOSE: Sir Denis Browne, a surgeon at the Hospital for Sick Children, Great Ormond Street, was the first surgeon to confine his practice solely to pediatric surgery. He made numerous important contributions to the field of pediatric surgery in orthopedics, otolaryngology, plastic surgery and urology, and is thus known as the father of modern British pediatric surgery. MATERIAL AND METHODS: We reviewed the original publications, historical records and medical literature on Denis Browne and his contributions to urology. RESULTS: Sir Denis Browne used his anatomical studies to elucidate many of the problems he faced. He classified undescended testis into two groups still recognized today: 'normal variations of development (retractile testis) which only need leaving alone' and 'congenital deformities which need operation'. During orchidopexy he stressed cord mobilization rather than testicular fixation and tension on the blood supply. He was also the first to describe the superficial inguinal pouch, which bears his name, as a common site for the undescended testis. He devised a new operation for hypospadias based on the principle that a buried strip of skin will epithelialize the surrounding tissue into a tube. The simplicity of his technique made hypospadias surgery available to the average surgeon. As an inventor, he designed many surgical instruments, including a circular retractor holder, as well as a universal golf club, a circular tennis racquet and a modified bicycle seat. CONCLUSIONS: Sir Denis Browne was an innovator and nonconformist with regard to the traditional teaching and practice of pediatric surgery and urology of his day. His innovations in surgical theory, technique and instrumentation resulted in major contributions to the advancement of urology as well as pediatric surgery.

The "infertility" of Catherine de Medici and its influence on 16th century France.

OBJECTIVE: Catherine de Medici, queen consort of King Henry II of France, was a powerful woman at a time when power for her sex was determined by fecundity. A decade long history of infertility might have placed her at risk for condemnation, but her husband's known urologic abnormalities played in her favor. This presentation will address the penile deformity of her husband, Henry II, and how this likely played a crucial role in her eventual rise to power, the interventions undertaken with regard to her purported infertility, and the historical ramifications when Catherine de Medici went on to have children. MATERIAL AND METHODS: A review of the literature of the lives of Catherine de Medici, King Henry II, and their children was completed. RESULTS: The inability to conceive an heir in the first decade of Catherine de Medici's marriage was attributed to Henry II, who was born with hypospadias and chordee. Through the intervention of Doctor Jean Fernel, the royal couple went on to have 10 children. When Henry II died in 1559 Catherine de Medici went on to rule France in the name of her sons for the next 3 decades, until her death in 1589. CONCLUSION: Henry II was born with hypospadias and chordee, and this contributed to the inability of Catherine de Medici to conceive a child for the first 10 years of their marriage. The cure of "her" infertility changed the course of history, as she subsequently ruled in the name of her sons following the death of Henry II.

Carlos II: Del hechizo a su patología génito-urinaria / Charles II: From spell to genitourinary pathology

OBJETIVO: Tratar de desentrañar la compleja patología del último rey de la dinastía de los Austrias, Carlos II, apodado El Hechizado, dentro de la cual la urogenital fue preponderante, impidiéndole cumplir con una de las finalidades de la institución monárquica cual es la transmisión a un descendiente y produciéndole una serie de complicaciones que le llevaron al fallecimiento.MÉTODOS: Revisamos las obras en las cuales se describe la vida del Rey, haciendo hincapié en sus antecedentes consanguíneos, en las dudas sobre su sexo en el momento del nacimiento, sus procesos patológicos, la repercusión en las Cortes Europeas, pero sobre todo en sus matrimonios y en la incapacidad para generar un heredero. Resaltamos como, siguiendo el pensamiento de la sociedad española del siglo XVII, hizo pensar que se encontraba hechizado. Sobrenombre con el que pasó a la historia.RESULTADO: Deducimos que pudo presentar un hipospadias posterior que junto con la monorquia y testículo atrófico, hace pensar que presentó un estado intersexual con genitales ambiguos. Su fenotipo físico inclina más hacia un hermafroditismo verdadero y sobre todo un varón XX, que hacia un síndrome de Klinefelter que ha sido el más atribuido. Es probable su asociación con un síndrome X frágil. Monorreno congénito muy posiblemente, su muerte se debió a una insuficiencia renal crónica producida por una glomerulopatía o una nefropatía intersticial a consecuencia de una litiasis renal más infecciones del tracto urinario recidivantes.CONCLUSIONES: Fruto de una reiterada política matrimonial endogámica, feneció en 1700 la dinastía de los Habsburgo en España encarnada en Carlos II, un monarca pluripatológico que sólo se libraría de especulaciones si se efectuaran estudios cromosómicos y genéticos de sus restos presentes en el monasterio de El Escorial(AU)

OBJECTIVES: We attempt to unravel the complex condition of the last king of the Hapsburg dynasty in Spain, Charles II, called The Bewitched, in whom a genitourinary disorder was preponderant, preventing him from fulfilling one of the objectives of the monarchial institution, engendering a heir, and causing a series of complications that led to his death. METHODS: We review the works describing the life of the King, with special emphasis on his bloodline, the doubts about his sex at birth, his pathological processes, the repercussion among European Courts, but above all on his marriages and the inability to engender an heir. We also emphasize the thought of 17th century Spanish society which led to the belief that he was bewitched. The nickname he passed into history with.RESULT: It was deduced that he could have presented posterior hypospadias which, together with monorchism and atrophic testicle, led to the belief that he presen-ted an intersexual state with ambiguous genitals. The physical phenotype leans more towards true hermaphro-ditism and above all a XX male, rather than the more often attributed Klinefelter’s syndrome. This is probably also associated with a fragile X syndrome. Very possibly congenital monorenal, death was due to chronic kidney failure caused by glomerulopathy or interstitial nephro-pathy as a consequence of renal lithiasis plus recurrent infections of the urinary tract.CONCLUSIONS: As a result of a reiterated endogamic matrimonial policy, the Hapsburg dynasty died out in Spain in 1700, represented by Charles II, a pluripatho-logical king who can only be freed from speculation by chromosomal and genetic studies of his remains buried in El Escorial monaster(AU)

Historical aspects of hypospadias--a literature review.

There is an ongoing search for solutions to many troublesome issues concerning surgical treatment of hypospadias such as what age is the most appropriate to apply surgery, or in how many stages surgery should be performed; what method, technique or modification to use in the surgical treatment of a specific type of hypospadias, whether there is an algorithm to use in choosing the most appropriate technique so that post-surgery complications could be reduced to minimum, or whether it is possible to follow up the early and late results of surgery. Knowing how treatment of hypospadias evolved from ancient times to present days can really help us find answers to some of these questions. Looking retrospectively into the past would enable us to follow the progress of the treatment of this anomaly by studying and analyzing the work of the famous surgeons from the past that left their mark in history. Beginning from the ancient times and passing through the Middle Ages and the revolutionary 19th century we come to the modern scientists who have described their clinical experience, methods and techniques and contributed considerably to the development of science. Many of the modern surgeons claim their ideas to be original but the investigation of historical documents and scientific works shows that all current techniques, theoretical and practical knowledge had been described ages before. It is quite apt here to quote Durham Smith on that: "There is nothing new in surgery not previously described".

[Contribution of Etienne-Frederic Bouisson (1813-1884) to the surgical treatment of hypospadias]. / Etienne-Frédéric Bouisson (1813-1884) et le traitement chirurgical de l'hypospadias.

Professor Bouisson was a great surgeon and benefactor of medicine. He exercised successfully the functions of dean, rector and deputy. A great part of his surgical work deal with pediatric urology. Bouisson's dissertation on surgical treatment of hypospadias constitute a crucial turning-point in the history of treatment of this malformation.

[Victor Rochet (1860-1934), founder of Lyons' Urology and his contribution to surgical treatment of hypospadias]. / Victor Rochet (1860-1934), fondateur de l'urologie lyonnaise et son apport a la cure chirurgicale de l'hypospadias.

Through this article we present the scientific portrait of Victor Rochet, founder of Lyons' Urology, and we emphasize on his two procedures of hypospadias' surgical treatment.

[Louis Ombrédanne (1871-1956) and the cure for hypospadias]. / Louis Ombrédanne (1871-1956) et la cure de l'hypospadias.

Ombrédanne was one of the founders of paediatric surgery. He was the inventor of surgery technics. His methods used in infantile urology became classics, such as hypospadias' operation.

Hypospadias repair in the 1990s.

Hypospadias is a congenital anomaly in which the urethral meatus is abnormally located anywhere from the glans to the perineum. Refinements in pediatric anesthesia, surgical technique and instrumentation, and a greater understanding of the psychologic and emotional issues related to hypospadias repair have led to this procedure being performed at an earlier age. The goal of reconstruction is to bring the urethral meatus to the tip of the penis, to correct associated penile curvature if present, to create a conical-shaped glans, and to achieve cosmetically acceptable penile shaft skin coverage. The surgical technique employed varies with the penile anatomy and surgeon's preference. Complications may occur both immediately and long after the surgical procedure, and thus follow-up is necessary.

The history of hypospadias.

The dictum, "There is nothing new in surgery not previously described", is particularly true of hypospadias. The major significance of chordee was fully appreciated by Galen in the second century A. D. and then almost forgotten until Mettauer in 1842, all previous surgeons overstressing the position of the orifice. Mettauer recognised skin shortening as a cause of chordee, a fact not re-discovered until 1967. Urethroplasty from penile skin in situ was well described by Thiersch in 1869 and Duplay in 1874; additional covering skin flaps were developed in 1892 by Lauenstein. The modern enthusiasm for pedicle tubes from prepuce was first employed by Van Hook in 1896, Rochet in 1899, Hamilton Russell in 1900, and Mayo in 1901; the "buried skin" technique of Denis Browne was described by Duplay in 1880, although attributed by Browne to Hamilton Russell in 1915. Even scrotal tissues were incorporated in repairs in 1860 (Bouisson). Beck, in 1898, practised a repair for balanitic hypospadias very similar to the modern MAGPI repair, and free grafts, so popularised in the last 20 years, were performed by Nové-Josserand in 1897. We have certainly advanced from the era of the first millenium A. D., in which the treatment was amputation beyond the orifice, but almost all present-day techniques are well-founded in ideas developed by enterprising surgeons of the last century.