One-Stage Repair of Hypospadias: Is There No Simple Method Universally Applicable to All Types of Hypospadias?

Abstract

A simple method of hypospadias repair is described. The operative technique consists of 7 steps, including 1) outlining the skin incision and dartos mobilization; 2) artificial erection, harvesting parameatal foreskin flap and release of chordee as needed; 3) glans splitting and creation of glanular wings; 4) 1-stage urethroplasty with parameatal foreskin flap; 5) meatal glanuloplasty; 6) creation of Byars' flaps of the skin, and 7) skin closure. Central to the technique is the feasibility of the choice of 1-stage urethroplasty with meatal based manta-wing flap or with parameatal based and fully extended circumferential foreskin flap even after the skin incision is made, which enables its application to all types of hypospadias. Of 120 patients the 1-stage urethroplasty was performed with meatal based manta-wing flap in 50, and with parameatal based and fully extended circumferential foreskin flap in 70. Primary success was obtained in 82% of the cases with meatal based manta-wing flap, and in 53% with parameatal based and fully extended circumferential foreskin flap. Complications requiring secondary repair occurred in 42 cases (9 with meatal based manta-wing flap, and 33 with parameatal based and fully extended circumferential foreskin flap) but repair was successful in 32. Thus, the overall success rate was 91% (96% with meatal based manta-wing flap, and 87% with parameatal based and fully extended circumferential foreskin flap). Additional repair (10 secondary, 2 tertiary and 1 quaternary) is planned in 13 cases. The technique of 1-stage urethroplasty with parameatal foreskin flap is recommended as a simple and reliable treatment for hypospadias with a reasonable success rate.

Hypospadias: Surgery and Complications

“…The procedure described by Koyanagi et al [12] (fig. 4) and its modification is in our experience very useful in cases where it is necessary to cut the urethral plate.…”

Lateral-based flap: a single stage urethral reconstruction for proximal hypospadias

“…The LB skin flap is a natural development of many wellestablished procedures that used the lateral skin such as those of Van Hook [11], Broadbent et al [13], DesPrez et al [14], Koyanagi et al [15], and Joseph [16].…”

Surgical Repair of Anterior Hypospadias with Fish-Mouth Meatus and Intact Prepuce Based on Anatomical Characteristics

“…The foreskin flap for urethroplasty can be harvested from either the ventral site as described by Mathiew in 1932 (fig. 2B) or the unilateral site of our original onlay urethroplasty for distal hypospadias (OUPF II) [5]. The glans is simultaneously split along with the cleft glanular groove to create the glans wings (fig.…”