Two-stage repair in hypospadias

Area of Science:

• Urology
• Pediatric Surgery
• Reconstructive Surgery

Background:

• Hypospadias repair is a common pediatric urological procedure.
• The one-stage tubularized incised plate urethroplasty is standard for most cases.
• Severe cases, hypospadias failures, and balanitis xerotica obliterans may benefit from a staged approach.

Purpose of the Study:

• To review the utility and outcomes of the two-stage approach in hypospadias repair.
• To compare the two-stage approach with one-stage methods for specific patient groups.

Main Methods:

• Nonsystematic review of the two-stage hypospadias repair technique.
• First stage: penile straightening and urethral plate substitution with grafts (preputial, oral mucosa, postauricular skin).
• Second stage (6 months later): urethroplasty via graft tubulization.

Main Results:

• Excellent graft take with minimal need for additional patches.
• Low morbidity: 6% fistula rate, 2% stricture rate.
• Long-term cosmetic results are excellent; however, voiding/ejaculatory issues may affect up to 40% if a long urethral tube is created.

Conclusions:

• The two-stage approach is a viable and effective option for complex hypospadias cases and revisions.
• While technically simple, experience improves outcomes and reduces complication rates.
• Waterproofing layers can significantly decrease fistula rates, and long-term functional outcomes require consideration.