title: Modified koyanagi repair for severe hypospadias.
abstract: OBJECTIVE
  To report the results of an early series of patients who underwent modified Koyanagi repair for severe hypospadias.
  
  
  METHODS
  A total of 24 boys (age: 9 months to 11 years) with proximal hypospadias, chordee, and poor urethral plate underwent modified Koyanagi repair between September 2008 and January 2012. Nine boys had associated penoscrotal transposition that was corrected simultaneously. Vascularized parameatal based foreskin flap was used to correct the hypospadias in a single stage. The follow-up ranged from 6 months to 3.5 years.
  
  
  RESULTS
  A total of 13 of the 24 children had a good outcome and were voiding normally, while 11 boys developed complications, 3 of which were major and 8 minor. The major complications were complete breakdown (n = 1), meatal and distal neourethral stenosis requiring laying open of distal urethra (n = 1), and glans breakdown (n = 1). The minor complications included fistulae (n = 5), meatal stenosis amenable to dilatation (n = 1), and lateral chordee (n = 1). Majority of the complications were in the initial patients, with successful outcomes in the last 1 year. Most of these complications were successfully managed by minor second procedures.
  
  
  CONCLUSIONS
  Modified Koyanagi repair not only corrects severe hypospadias with chordee but also corrects the associated penoscrotal transposition in a single stage. The results are good once the learning curve is crossed.
authors.affiliation: Department of Paediatric Surgery, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India ; Bangalore Medical College and Research Institute, Bangalore, Karnataka, India.
authors.forename: Deepti
authors.initials: D
authors.lastname: Vepakomma
authors.forename: Anand
authors.initials: A
authors.lastname: Alladi
authors.forename: Raghu S
authors.initials: RS
authors.lastname: Ramareddy
authors.forename: Tanveer
authors.initials: T
authors.lastname: Akhtar
keywords: Chordee; modified Koyanagi; parameatal foreskin flap; proximal hypospadias
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