Two-stage urethroplasty is a better choice for proximal hypospadias with severe chordee after urethral plate transection: a single-center experience

Abstract

It is still debatable whether single- or two-stage urethroplasty is a more suitable technique for treating hypospadias with severe chordee after urethral plate transection. This retrospective study evaluated these two techniques. A total of 66 patients of proximal hypospadias with severe chordee were divided into two groups according to the techniques they underwent: 32 and 34 patients underwent single-stage (Duckett) or two-stage urethroplasty, respectively. Median ages at presentation were 7.5 years and 11.0 years in single-stage and two-stage repair groups, respectively. Median follow-ups were 28.5 months (20−60 months) and 35 months (18−60 months) in the single-stage and two-stage groups, respectively. The meatus of the neourethra was located at the top of the glans in all patients. No recurrence of chordee was found during follow-up, and all patients or parents were satisfied with the penile length and appearance. Complications were encountered in eight patients in both groups, with no statistically significant differences between the two techniques. The late complication rate of stricture was higher after the single-stage procedure (18.75% vs 0%). The complication rate after single-stage repairs was significantly lower in the prepubescent subgroup (10.52%) than in the postpubescent cohort (46.15%). These results indicate that the urethral plate transection effectively corrects severe chordee associated with proximal hypospadias during the intermediate follow-up period. Considering the higher rate of stricture after single-stage urethroplasty, two-stage urethroplasty is recommended for proximal hypospadias with severe chordee after urethral plate transection.

Tissue transfer techniques in reconstructive urology

“…The majority of urethral reconstructions can be performed in one stage. A two-stage repair may be advantageous in cases requiring extensive reconstruction, such as that for hypospadias cases and urethral strictures due to lichen sclerosis [ 53 62 63 ]. In a two-stage procedure, the damaged area is opened, and a new urethral plate is created with grafts ( Fig.…”

Our experience of proximal hypospadias repair using the Cloutier–Bracka technique at the Gynaeco-Obstetric and Paediatric Hospital, Yaounde-Cameroon

“…Reconstruction of severe hypospadias using two-staged techniques is associated with an overall lower rate of complications, about 2.5–6% as reported in the literature[12] compared to one stage techniques. There is less room for this debate in sub-Saharan Africa as a significant number of cases are already circumcised.…”

Comparative study of urethroplasties to reduce urethral strictures in patients with severe hypospadias

“…The preserved UP ends can be used as a stent to improve the quality of the new urethra. 21 When UP preservation is used, blood supply for neourethra is better than Duckett urethroplasty, and healing time of suture lines is shorter. What’s more, the back side of urethra attach to the corpora cavernosa of the penis, which is good for the reconstructed urethra.…”