Single Stage Urethroplasty for Proximal Hypospadias with Chordee

Abstract

Proximal hypospadias with chordee usually requires two stage procedures: 1 st stage is orthoplasty and ventral parking of prepucial skin and 2 nd stage is urethroplasty after 6 months of 1 st stage. The aim of this study is to describe and report the outcome of a single stage repair-Koyanagi Nanamura procedure for proximal hypospadias with chordee. Between January 2006 to December 2010, 44 boys with proximal hypospadias underwent repair using the Koyanagi Nanamura technique in Paediatric Surgery Department of Faridpur Medical College Hospital and Dhaka Medical College Hospital. The boys' age ranged from 1 to 7 years. The technique employs the use of lateral penile skin and extends into the inner preputial skin. This flap enjoys double blood supply from the base of the meatus as well as the preputial vessels. Follow-up period was 6 months. Satisfactory results were obtained in 39 (88.6%) patients. Three patients developed fistulae. Two patients developed meatal stenosis. Results were considered satisfactory when the boy achieves a glanular meatus, single forward stream, unimpeded voiding, good cosmesis, and no need for secondary surgery for the urethra. Koyanagi Nanamura procedure is a reliable procedure in which the lateral flaps have dual blood supply, which produces good results (88.6%) and is suitable for proximal forms of hypospadias with chordee.

Penoscrotal Hypospadias, A 4- Year Follow-Up

“…In the evaluation on seven days after urethroplasty surgery and catheter removal, there was a urethrocutaneous fistula in the mid-shaft penile. These complications could arise in urethral repair surgery, especially in the proximal part (8,11). As in the previous study, in this case report, there was no evidence of urethral stenosis or stricture after using a stent for seven days (12).…”

“…In 1983, Koyanagi et al innovated a technique for hypospadias repair using a parameatal-based flap that extends distally around the distal shaft to insert the inner layer of the prepuce. Although the technique seems specifically applicable to penoscrotal hypospadias, its use has resulted in a high complication rate with re-surgery in 20-50% of the cases (8). Modifications to this technique have been made in an attempt to improve blood supply, aiming to reduce complications (9).…”