Staged tubularized preputial graft in proximal hypospadias, are we in the right direction?

Hypospadias is one of the most common congenital defects of male external genitalia. Correction of severe ventral curvature remains a main challenge to surgeons. The aim of this work was to assess short term outcomes of the staged tubularized preputial graft in primary proximal hypospadias with severe ventral curvature in our center with the hypothesis that it's comparable to published results in the two stage repair technique.

A retrospective analysis of prospectively collected data that included 40 children was done, who had primary proximal hypospadias with moderate to severe ventral curvature (Study period started in December 2019 till January 2023). All patients had undergone staged tubularized preputial graft repair. Complication rates were evaluated. Cosmetic and functional outcomes were assessed using HOSE score.

Forty patients aged from 6 months to 8 years had proximal hypospadias with ventral curvature with a mean ventral curvature 56.13 ± 18.96° after complete penile degloving. At the second stage all grafts were taken except in two patients. Following the first stage, 4 patients only had mild residual curvature that were corrected in the second stage. Over a median (IQR) follow up of 2.9 (1.2-4.0) years after second stage, 5 patients (13.1 %) had glans dehiscence, 6 patients (15.8 %) had urethro-cutaneous fistula, 4 patients had meatal stenosis (8 %), and two patients had neourethral stricture (5.3 %). Twenty-one patients had HOSE score 15 out 16 and others had score ranged from 12 to 14.

Repair of proximal hypospadias with severe curvature remains a challenge to paediatric urologists. A two-stage hypospadias repair with preputial grafting has achieved comparable success to other techniques. Complications (specifically glanular dehiscence and fistulas) should be explained thoroughly to the parents/caregivers which might need additional surgeries to correct it in the future.