title: Choosing a technique for severe hypospadias.
abstract: BACKGROUND
  We participate in humanitarian missions in Madagascar during which we treat severe hypospadias. We report our experience and results with these patients, in these conditions, and discuss our choice of technique in this particular setting.
  
  
  METHODS
  We retrospectively reviewed the data of 27 patients operated for severe hypospadias during our humanitarian missions in Madagascar between November 2006 and September 2009. Twenty one patients underwent a modified Koyanagi procedure, three underwent a Duckett urethroplasty, two an onlay island flap, one an augmented Duckett and one a tubularised plate urethroplasty. Two patients who underwent a modified Koyanagi repair also had a Nesbitt dorsal plication.
  
  
  RESULTS
  Patient age at the time of surgery ranged from 22 to 198 months with a median age of 54.1 months. Mean follow-up was 16 months. Of the 21 patients who underwent a modified Koyanagi procedure, 16 presented at least one complication (76%): A fistula developed in 12 patients (57%), meatal regression developed in 7 (33%) and 2 showed complete wound dehiscence (9.5%). None developed stenosis or urethrocoele.
  
  
  CONCLUSIONS
  In this particular setting, the postoperative complication rate is high. Nevertheless, the Koyanagi technique is appropriate, because its complications are easy to treat and there is always sufficient ventral tissue for the secondary operation, if necessary.
authors.affiliation: Department of Paediatrics Surgery, CHR F Guyon, Bellepierre, Saint-Denis de La Réunion, Reunion Island, Madagascar.
authors.forename: Alexis
authors.initials: A
authors.lastname: Arnaud
authors.forename: Luke
authors.initials: L
authors.lastname: Harper
authors.forename: Marie-Benedicte
authors.initials: MB
authors.lastname: Aulagne
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Michel
authors.forename: Aude
authors.initials: A
authors.lastname: Maurel
authors.forename: Eric
authors.initials: E
authors.lastname: Dobremez
authors.forename: Laurent
authors.initials: L
authors.lastname: Fourcade
authors.forename: Lalatiana
authors.initials: L
authors.lastname: Andriamananarivo
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D007223:Infant; D008297:Male; D010413:Penis / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D014521:Urethra / Q000601:surgery; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects / Q000379:methods*