First-stage procedure for proximal hypospadias with penile encasement/scrotal transposition (PEST) deformity

We hereby report Curvature correction, Lateral foreskin Approximation & Scrotal Switch (CLASS) procedure as a first-stage of Penile encasement/scrotal transposition (PEST) deformity & proximal-hypospadias. At first stage, the encased penis was released by making two inverted "U" shaped incisions on either side of two hemi scrota; the dorsal foreskin was left attached to glans; lateral foreskin flaps, straightened at the coronal sulcus, were approximated in the midline after chordee correction. Fifteen patients with perineal hypospadias & PEST deformity underwent CLASS procedure and second stage with good success. Further large prospective studies are essential to validate this procedure.