Two-stage repair for proximal hypospadias: A reappraisal

Abstract

Great advances have been made in surgery for the correction of hypospadias. Proximal hypospadias remains the greatest challenge, but, despite many innovations and much progress, surgery can fail. Many authorities have introduced single-stage techniques, which have the purported advantage of correcting the defect with minimal hospitalization and family inconvenience. However, the wider published experience with these approaches would suggest that the ideal single-stage procedure has yet to be devised. A substantial number of children undergoing a single-stage procedure will have to undergo further surgery. A small, but irreducible number of patients will be rendered hypospadias "cripples." A number of these children will be dissatisfied as adults because of cosmetic or functional deficiencies. A two-stage approach for correction of proximal hypospadias and severe chordee remains the most credible and reliable solution for many of these patients. Pediatric urologists should maintain familiarity with these techniques and continue to advocate them for a select group of patients.

Hypospadias Repair: An Overview of the Actual Techniques

“…44 This is not such a problem with two-staged repairs because they allow aggressive correction of the chordee. 45…”

“…Recent technical modifications of the two-staged reconstruction have been made whereby chordee is corrected more aggressively. 45,57 Some prefer to raise a dartos flap and transpose it ventrally to allow for a wider graft bed that is well-vascularized. This allows better graft take and recurrence of chordee is rare.…”

“…It is generally true and well recognized that there is always sufficient preputial skin for grafting in primary cases and is still the best source for the graft. 45,55,57 For redo cases, postauricular graft is a choice of extra genital source of graft when necessary. Local excess shaft skin following previous surgery could be used if not scarred.…”

Outcome of Hypospadias Surgery in Children;

“…Due to deficiency of urethral plates and covering tissues, it may not be possible to straighten the penis completely and prepare the ventral surface for urethroplasty. 4,16,17 In total 59 patients, Bracka stage 1 was done. Adequate mobilization of glans wings done followed by inner prepucial grafting on raw ventral surface of penis giving flexibility of tissues available for second stage in TIP.…”