title: Long-term results with a one-stage complex primary hypospadias repair strategy (the three-in-one technique).
abstract: OBJECTIVE
  Complex primary hypospadias repair that warrants urethral plate division is treated mostly in two steps, not necessarily in two surgeries. Our aim was to review long-term results with a one-stage strategy based on reconstruction of the urethral plate with buccal mucosa graft and onlay transverse preputial flap anastomosis protected by a tunica vaginalis flap (the three-in-one concept).
  
  
  METHODS
  We were able to report on 35 patients operated for primary scrotal, penoscrotal and perineal hypospadias between March 2002 and June 2008. We reviewed all charts and had phone interviews with patients not seen for the last 24 months. We investigated parameters such as UTI occurrence, fistula, residual curvature, meatal stenosis, urethral diverticula, dehiscence, orchitis and parental perception.
  
  
  RESULTS
  Surgical complications occurred in 13 patients (37%): 4 meatal stenosis, 4 diverticula, 5 fistulae and 2 residual penile curvatures (total 42%). Meatal dilatation was successful in 2 cases, reflected in fistula resolution. The reoperation rate was 31.5% consisting mostly of simple procedures like fistula closure, meatotomy and penile curvature release, and complex diverticula repair in 4 cases. Parental perception was excellent for 57% (20 patients) and good or acceptable for the remaining. Mean follow-up was 4.6 years.
  
  
  CONCLUSIONS
  The one-step strategy is associated with 68.5% success in a single operation, whereas 31.5% will need a second repair. We recognize that meatal problems are mostly associated with fistulae and diverticula; therefore, we recommend a final acceptable proximal glandar opening that will not compromise the neourethra.
authors.affiliation: Department of Urology, Federal University of São Paulo, Rua Maestro Cardim, 560/215, 01323-000 São Paulo SP, Brazil. macedo.dcir@epm.br
authors.forename: Antonio
authors.initials: A
authors.lastname: Macedo
authors.forename: Riberto
authors.initials: R
authors.lastname: Liguori
authors.forename: Sergio L
authors.initials: SL
authors.lastname: Ottoni
authors.forename: Gilmar
authors.initials: G
authors.lastname: Garrone
authors.forename: Eulalio
authors.initials: E
authors.lastname: Damazio
authors.forename: Ricardo M
authors.initials: RM
authors.lastname: Mattos
authors.forename: Valdemar
authors.initials: V
authors.lastname: Ortiz
mesh_terms: D000714:Anastomosis, Surgical; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D008297:Male; D009061:Mouth Mucosa / Q000637:transplantation*; D010413:Penis / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000379:methods*