A Comparative Study on Cosmetic and Functional Outcome in Patients Undergoing Single and Staged Repair for Proximal...

Proximal Penile Hypospadias (PPH) pose significant functional and cosmetic challenges. While two-stage repair is the traditional approach, single-stage techniques are increasingly used with favorable outcomes. Objective cosmetic assessment remains difficult; thus, the modified Pediatric Penile Perception Score (PPPS), incorporating phallic length and a meatal-glans complex, offers a simplified yet structured evaluation method. This study compares the functional and cosmetic outcomes of single-stage versus staged urethroplasty.

This randomized observational study included 46 patients aged 6 months to 12 years with PPH and chordee >15°, excluding those with syndromic features, penoscrotal transposition, penile skin disease, or prior circumcision. Patients were randomized into single-stage (n = 24) and staged (n = 22) urethroplasty groups. Functional (complication-based) and cosmetic (modified PPPS score-based) outcomes were evaluated at 3 months postoperatively. Cosmetic evaluation was done both by a surgeon and by a parent.

Both the groups were age-matched, though anatomical variation remained. Urethrocutaneous fistula was the most common complication, occurring at similar rates (58.3% single-stage vs. 54.5% staged; P = 0.796). Meatal stenosis/retraction was more frequent in the single-stage group (16.7%), but not statistically significant (P = 0.110). Cosmetic scores for phallus and meatal-glans complex favored single-stage repair, while overall appearance slightly favored staged repair.

Both approaches yielded comparable functional outcomes. Single-stage repair showed better results in specific cosmetic domains, while staged repair offered marginally higher overall satisfaction. Parents were more critical in evaluating overall appearance, while surgeons evaluated meatal-glans complex scores more effectively.