Two-stage repair for severe hypospadias

Area of Science:

• Pediatric Urology
• Surgical Reconstruction
• Genitourinary Surgery

Background:

• Hypospadias and chordee are common congenital penile abnormalities requiring surgical correction.
• Severe cases present significant challenges for functional and cosmetic outcomes.
• Existing surgical techniques may involve complex reconstructions and potential complications.

Purpose of the Study:

• To evaluate the efficacy and outcomes of a 2-stage modified Belt-Fuqua repair for severe hypospadias and chordee.
• To assess the complication rates and functional results of this specific surgical approach.
• To determine the long-term cosmetic and functional satisfaction in pediatric patients.

Main Methods:

• A retrospective review of 39 patients who underwent a 2-stage modified Belt-Fuqua repair for severe hypospadias and chordee.
• Analysis of patient demographics, preoperative meatal location, use of testosterone, and concurrent chordee correction (Nesbit procedure).
• Evaluation of neourethral length, complication rates (diverticula, strictures, fistulas), and follow-up outcomes.

Main Results:

• The 2-stage repair was performed in 39 patients with an average age of 2 years at the first stage.
• Complications included neourethral diverticula in 21% (repaired uneventfully) and minor urethral strictures in 18%.
• Excellent cosmetic and functional outcomes were reported in all patients, with minimal fistula formation.

Conclusions:

• The 2-stage modified Belt-Fuqua repair is a safe and reliable alternative for severe hypospadias and chordee.
• This approach avoids grafts and allows for staged reconstruction, improving outcomes.
• The technique minimizes penile deformities, torsion, asymmetry, and complications like fistulas and strictures.