Original Koyanagi urethroplasty versus modified Hayashi technique: outcome in 57 patients.
OBJECTIVE
To compare outcomes of the original Koyanagi technique with the Hayashi modification in severe hypospadias, i.e. hypospadias with a division of the corpus spongiosum located behind the penile midshaft associated with marked hypoplasia of the ventral aspect of the penis and a non-preservable urethral plate. Choice of technique for treating severe hypospadias is discussed.


METHODS
Twenty-six patients (group I) were operated in Lyon using the original Koyanagi procedure and 31 (group II) underwent a modified Hayashi procedure in Paris. Most patients received preoperative androgenic stimulation. Mean follow up was 25 months (group I) and 34 months (group II).


RESULTS
Sixteen patients (61.5%) in group I and 19 (61.3%) in group II developed complications leading to 21 additional procedures in each group. Urethral dehiscence was found in 11/26 patients in group I (42.3%), and in 6/31 patients in group II (19.3%); fistulae were respectively found in 5/26 (19.2%) and 12/31 (38.7%), and stenosis in 9/26 (34.6%) and 5/31 (16.1%) patients. Urethrocele was found in 7/26 (26.9%) and 5/31 (16%) patients, respectively. Twelve (group I) and 7 (group II) patients are awaiting re-operation.


CONCLUSIONS
Although the complication rate is quite similar between the original and the modified Koyanagi procedure, the Hayashi technique seems to provide a better distal blood supply to the reconstructed urethra.
Catti
Massimo
M
Department of Paediatric Urology, Hôpital Mère Enfants - Groupe Hospitalier Est, 59, Boulevard Pinel, 69677 Bron Cedex, France.
Lottmann
Henri
H
Babloyan
Sergei
S
Lortat-Jacob
Stephen
S
Mouriquand
Pierre
P
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007021:Hypospadias / Q000473:pathology / Q000601:surgery*; D007223:Infant; D008297:Male; D010413:Penis / Q000002:abnormalities / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation; D012720:Severity of Illness Index; D013529:Surgical Wound Dehiscence / Q000601:surgery; D016896:Treatment Outcome; D014521:Urethra / Q000002:abnormalities / Q000601:surgery*; D014525:Urethral Stricture / Q000601:surgery; D014548:Urinary Fistula / Q000601:surgery; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects* / Q000379:methods*