title: Bracka's staged repair of proximal hypospadias--revisiting a versatile technique.
abstract: OBJECTIVE
  Proximal hypospadias is associated with poorly defined urethral plate and often with chordee. A two-staged Bracka's repair is reproducible and has been used routinely in our practice. We present the key steps of this technique on a 13-month-old boy.
  
  
  METHODS
  This boy presented with proximal penile hypospadias, hooded foreskin and mild chordee. He underwent stage one Bracka's repair. The steps included: 1) Artificial erection test to define extent of chordee; 2) inner preputial graft harvest and preparation; 3) glans and urethral plate incision down to corpora cavernosa; 4) partial release of chordee by division of aberrant corpus spongiosum, without degloving of penile skin; 5) laying of preputial graft; 6) dressing.
  
  
  RESULTS
  The patient had catheter removed on second, and dressing removed on seventh, post-operative days, without complication. The patient is planned for second stage repair in 6 months. Our standard approach includes either removal of catheter on the second or seventh post-operative day, according to surgeon preference. The three senior surgeons have used this method in 54 patients without significant complication. The graft has taken in 100% of cases.
  
  
  CONCLUSIONS
  The Bracka's staged repair of proximal hypospadias is a versatile technique that gives reproducible and sound results.
authors: Department of Paediatric Surgery, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK. ywtan80@doctors.net.uk
authors: Yew-Wei
authors: YW
authors: Tan
authors: Nakul
authors: N
authors: Patel
authors: Alexandra
authors: A
authors: Scarlett
authors: John
authors: J
authors: Clibbon
authors: Milind
authors: M
authors: Kulkarni
authors: Azad
authors: A
authors: Mathur
mesh_terms: D005500:Follow-Up Studies; D052816:Foreskin / Q000601:surgery; D006085:Graft Survival; D006801:Humans; D007021:Hypospadias / Q000175:diagnosis / Q000601:surgery*; D007223:Infant; D008297:Male; D010413:Penis / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation / Q000379:methods; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*