Staged proximal hypospadias repair: Modified thiersch duplay with midline incision in urethral plate followed by Mathieu urethroplasty.
OBJECTIVE
Functional results, complications, cosmesis, operating time, and hospital stay were analyzed after staged urethroplasty for proximal hypospadias.


METHODS
Seventeen consecutive boys, mean age 17.7 +/- 1.6 months underwent a staged urethroplasty in the past 5 years. Urethral plate was tubularized and proximal hypospadias converted to distal. Hooded dorsal prepuce was buttonholed and transposed ventrally to cover the neo-urethra. Subsequently, a parameatal based flip flap urethroplasty completed the urethral reconstruction at mean age of 26.7 +/- 4.1 months.


RESULTS
Mean follow-up time was 2.8 +/- 1.7 years. Eighty-eight percent of boys who are now toilet trained and standing to void have a good caliber straight single stream of urine in a forward direction. Urethrocutaneous fistula was seen in 1 child (6%), and a simple fistulectomy with double layered closure was successful at first attempt of fistula closure. Cosmetic appearance of a natural vertical slit glanular meatus situated at normal position on the glans was achieved in all patients. Total mean operating time was 193.5 +/- 42.9 minutes and total mean duration of hospital stay was 3.4 +/- 0.6 days.


CONCLUSIONS
Staged urethroplasty for proximal hypospadias results in a normal penis with good function, minimal complications, and excellent cosmesis.
Samuel
M
M
Department of Pediatric Surgery, St George's Health Care NHS Trust, London, England.
Capps
S
S
D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D007223:Infant; D008297:Male; D010413:Penis / Q000601:surgery; D024162:Second-Look Surgery; D014521:Urethra / Q000601:surgery*; D014554:Urination