Outcome of severe hypospadias repair using three different techniques.
OBJECTIVE
To compare the outcomes of three different urethroplasty techniques (onlay, buccal mucosa, Koyanagi type I) used in the reconstruction of severe hypospadias.


METHODS
Over 10 years (1997-2007), 300 severe hypospadias cases were treated with a mean follow up of 2 years (1-105 months); 203 were operated by the same surgeon of whom 184 completed follow up. Three main techniques were used according to the quality of the urethral plate: onlay urethroplasty (133), buccal graft urethroplasty (25) and Koyanagi type I (26). The mean age at surgery was 36 months (8-298); 76 required preoperative androgen stimulation (onlay 37, buccal 11, Koyanagi 26); 18 required a corporoplasty to straighten the penis (onlay 13, buccal 3, Koyanagi 2).


RESULTS
Thirty-eight onlay (28.5%); 14 buccal (56%); 16 Koyanagi (61.5%) urethroplasties had a complication. The fistula rate was 15% for the onlay group; 32% for the buccal mucosa group; 19.2% for the Koyanagi cases. The dehiscence rate was, respectively, 11.3%, 20% and 42.3%. The stricture rate was, respectively, 1.5%, 20% and 34.6%. Urethrocele was found in seven Koyanagi patients. Final functional and cosmetic results were satisfactory in 126/133 (94.7%) onlay, 20/25 (80%) buccal and 14/26 Koyanagi (53.8%) urethroplasties. Primary cases had better results (89%) than redo cases (75.9%). Patients submitted to preoperative androgen therapy developed more complications (onlay: 40.5% vs 23.9%; buccal: 70% vs 43.7%).


CONCLUSIONS
Two striking results are the low number of severe hypospadias cases requiring an additional corporoplasty, and the increased complication rate found in androgen-stimulated patients. The excellent results of the onlay procedure could be related to the use of dorsal preputial tissue, which in hypospadias is characterized by a well-balanced protein platform compared to the ventral tissues.
de Mattos e Silva
Elisângela
E
Department of Pediatric Urology, Hôpital Mère-Enfants - GHE, Groupe Hospitalier Est, Université Claude-Bernard, 59, Boulevard Pinel, Lyon I, 69677 Bron Cedex, France.
Gorduza
Daniela B
DB
Catti
Massimo
M
Valmalle
Anne Frédérique
AF
Demède
Delphine
D
Hameury
Frédéric
F
Pierre-Yves
Mure
M
Mouriquand
Pierre
P
D000293:Adolescent; D001458:Bandages; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007021:Hypospadias / Q000453:epidemiology / Q000601:surgery*; D007223:Infant; D008297:Male; D009061:Mouth Mucosa / Q000637:transplantation; D010413:Penis / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013524:Surgical Flaps; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014548:Urinary Fistula; D013521:Urologic Surgical Procedures, Male / Q000379:methods*; D055815:Young Adult