title: Severe hypospadias repair with meatal based paracoronal skin flap: the modified Koyanagi repair.
abstract: OBJECTIVE
  Various techniques have been reported to repair severe hypospadias. The Koyanagi repair uses a meatal based foreskin flap. We modified this procedure and reviewed the outcome of the repair of severe hypospadias.
  
  
  METHODS
  The modified Koyanagi repair was performed in 151 children 7 months to 15 years old (mean age 3 years) with severe hypospadias. The records of these patients were reviewed. In all cases the meatus was at or proximal to the penoscrotal junction. Followup was 6 months to 16 years (mean 6 years). Flap design is the same as in the Koyanagi repair, although our modified technique requires removal of the subcutaneous tissue of the distal portion of the flap, which acts as a full-thickness free skin graft.
  
  
  RESULTS
  A fistula developed in 19 patients (12.6%), meatal stenosis in 3 (2%) required meatoplasty and infection in 2 (1.3%) resulted in a regressed meatal position. Good cosmetic results were achieved in all except the latter 2 cases.
  
  
  CONCLUSIONS
  Our modified Koyanagi repair affords an excellent cosmetic appearance. The complication rate is relatively low and compares favorably with that of other techniques.
authors.affiliation: Department of Urology, Kobe Children's Hospital, Kobe, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Sugita
authors.forename: S
authors.initials: S
authors.lastname: Tanikaze
authors.forename: K
authors.initials: K
authors.lastname: Yoshino
authors.forename: F
authors.initials: F
authors.lastname: Yamamichi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012720:Severity of Illness Index; D013524:Surgical Flaps; D013521:Urologic Surgical Procedures, Male / Q000379:methods