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. 2008 Apr;24(2):226-32.
doi: 10.4103/0970-1591.40620.

Two-stage repair in hypospadias

K N Haxhirexha, M Castagnetti, W Rigamonti, G A Manzoni

Two-stage repair in hypospadias

K N Haxhirexha et al. Indian J Urol. 2008 Apr.

Abstract

We provide the reader with a nonsystematic review concerning the use of the two-stage approach in hypospadias repairs. A one-stage approach using the tubularized incised plate urethroplasty is a well-standardized approach for the most cases of hypospadias. Nevertheless, in some primary severe cases, in most hypospadias failures and in selected patients with balanitis xerotica obliterans a two-stage approach is preferable. During the first stage the penis is straightened, if necessary and the urethral plate is substituted with a graft of either genital (prepuce) or extragenital origin (oral mucosa or postauricular skin). During the second stage, performed around 6 months later, urethroplasty is accomplished by graft tubulization. Graft take is generally excellent, with only few cases requiring an additional inlay patch at second stage due to graft contracture. A staged approach allows for both excellent cosmetic results and a low morbidity including an overall 6% fistula rate and 2% stricture rate. Complications usually occur in the first year after the second stage and are higher in secondary repairs. Complications tend to decrease as experience increases and use of additional waterproofing layers contributes to reduce the fistula rate significantly. Long-term cosmetic results are excellent, but voiding and ejaculatory problems may occur in as much as 40% of cases if a long urethral tube is constructed. The procedure has a step learning curve but because of its technical simplicity does not require to be confined only to highly specialized centers.

Keywords: Balanitis xerotic obliterans; buccal mucosa; hypospadias; hypospadias cripple; staged repair.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Primary case with underdeveloped urethral plate suitable for substitution
Figure 2
Figure 2
Penis after removal of the ventral remnants and deep midline incision of the glans. Inset: proximal urethrostomy
Figure 3
Figure 3
Preputial graft
Figure 4
Figure 4
Graft harvesting from the lower lip (a and b) and from the inner check (c and d)
Figure 5
Figure 5
Buccal mucosa graft de-fatting
Figure 6
Figure 6
Final appearance of the graft at the end of first stage
Figure 7
Figure 7
Second stage
Figure 8
Figure 8
Graft contracture
Figure 9
Figure 9
Second layer for urethroplasty coverage
Figure 10
Figure 10
Final appearance
See this image and copyright information in PMC

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