title: The Bracka two-stage repair for severe proximal hypospadias: A single center experience.
abstract: BACKGROUND
  Surgical correction of severe proximal hypospadias represents a significant surgical challenge and single-stage corrections are often associated with complications and reoperations. Bracka two-stage repair is an attractive alternative surgical procedure with superior, reliable, and reproducible results.
  
  
  OBJECTIVE
  To study the feasibility and applicability of Bracka two-stage repair for the severe proximal hypospadias and to analyze the outcomes and complications of this surgical technique.
  
  
  METHODS
  This prospective study was conducted from January 2011 to December 2013. Bracka two-stage repair was performed using inner preputial skin as a free graft in subjects with proximal hypospadias in whom severe degree of chordee and/or poor urethral plate was present. Only primary cases were included in this study. All subjects received three doses of intra-muscular testosterone 3 weeks apart before first stage. Second stage was performed 6 months after the first stage. Follow-up ranged from 6 months to 24 months.
  
  
  RESULTS
  A total of 43 patients operated for Bracka repair, out of which 30 patients completed two-stage repair. Mean age of the patients was 4 years and 8 months. We achieved 100% graft uptake and no revision was required. Three patients developed fistula, while two had metal stenosis. Glans dehiscence, urethral stricture and the residual chordee were not found during follow-up and satisfactory cosmetic results with good urinary stream were achieved in all cases.
  
  
  CONCLUSIONS
  The Bracka two-stage repair is a safe and reliable approach in select patients in whom it is impractical to maintain the axial integrity of the urethral plate, and, therefore, a full circumference urethral reconstruction become necessary. This gives good results both in terms of restoration of normal function with minimal complication.
authors.affiliation: Department of Pediatric Surgery, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India.
authors.forename: Rakesh S
authors.initials: RS
authors.lastname: Joshi
authors.affiliation: Department of Pediatric Surgery, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India.
authors.forename: Mitesh K
authors.initials: MK
authors.lastname: Bachani
authors.affiliation: Department of Pediatric Surgery, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India.
authors.forename: Amit M
authors.initials: AM
authors.lastname: Uttarwar
authors.affiliation: Department of Pediatric Surgery, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India.
authors.forename: Jaishri I
authors.initials: JI
authors.lastname: Ramji
keywords: Bracka repair; proximal hypospadias; two-stage repair
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