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One-stage surgical correction of proximal hypospadias
1Division of Paediatric Surgery, KK Women's & Children's Hospital, 100 Bukit Timah Road, Singapore 229899.
Insights
Single-stage surgical repair effectively corrects severe proximal hypospadias. This approach offers satisfactory cosmetic and functional outcomes with lower morbidity compared to staged procedures.
Area of Science:
- Pediatric Urology
- Surgical Reconstruction
- Genitourinary Development
Background:
- Proximal hypospadias presents significant surgical challenges due to complex abnormalities.
- Staged repair methods are often employed for severe cases.
- Precise definition of deformity components enables single-stage operative solutions.
Purpose of the Study:
- To evaluate the efficacy of a single-stage surgical repair for severe proximal hypospadias.
- To assess functional and cosmetic outcomes of the one-stage procedure.
- To compare the results with traditional staged repair techniques.
Main Methods:
- A cohort of 26 patients with severe proximal hypospadias underwent a one-stage repair.
- Chordee was corrected by excising fibrotic dartos tissue and dysplastic urethral plate.
- Urethral reconstruction involved tubularizing a preputial skin flap and onlay grafting for glandular reconstruction.
Main Results:
- Follow-up ranged from 1 to 5 years (median 2 years).
- No fistulas were observed; two patients had mild meatal stenosis responsive to dilatation.
- One proximal anastomotic stricture required secondary correction; other patients achieved satisfactory functional and cosmetic results.
Conclusions:
- Single-stage repair is a viable and successful option for severe proximal hypospadias.
- Meticulous surgical technique and careful reconstructive design are crucial.
- This approach yields results comparable to staged procedures with significantly reduced morbidity.
Introduction:
Proximal hypospadias poses major problems in surgical correction owing to the complexity and severity of the abnormalities, leading to the use of staged repairs to correct this condition. However, with precise definition of the components of this deformity a single-stage operation can be developed and applied successfully for surgical correction of this condition.
Materials And Methods:
Twenty-six patients with severe proximal hypospadias were subjected to a one-stage repair. Excision of proximal fibrotic dartos tissue and removal of dysplastic urethral plate tissue corrected chordee completely. Urethral reconstruction was then performed by tubularising a flap of dorso-lateral preputial skin which was then anastomosed to the proximal urethra. The glandular part of the urethra was reconstructed using the distal part of the flap as an onlay graft over the meatal groove. The suture lines were covered with a layer of dartos tissue and skin closure was completed by transposing dorsal skin to surface the ventral penile shaft. A urethral catheter was left in for 10 days.
Results:
All patients have been followed up after surgery from 1 to 5 years with a median period of 2 years. There were no fistulas. Two patients had mild stenosis at the meatus which responded to dilatation. One patient developed a stricture at the proximal anastomosis which required secondary correction. All other patients achieved satisfactory correction, both in terms of voiding and in the cosmetic appearance of the genitalia.
Conclusion:
Single-stage repair of hypospadias can be successfully applied in the correction of severe proximal hypospadias. It requires meticulous dissection and careful design of reconstructive techniques. The end results are comparable to staged procedures and morbidity is significantly lower.