Challenges in managing proximal hypospadias: A 17-year single-center experience
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In brief
In brief
This 17-year retrospective study of 100 proximal hypospadias cases compares single-stage versus two-stage surgical approaches, with 64% managed in one stage. Overall complication rates included 26% urethral fistulae and 16% meatal stenosis, with no significant difference between techniques though outcomes improved over time.
Written by the GCMD Library team from the article.
Background
There are only a few publications in the medical literature reporting on complication rates in proximal hypospadias surgery, particularly with regard to long-term follow-up.
Methods
Over a 17.5-year period, we operated 100 patients with penoscrotal, scrotal and perineal hypospadias. Sixty-four had a single-stage repair, including 15 who received a buccal mucosa inlay "Snodgraft" repair. Thirty-six had a two-stage Bracka repair of which 19 received buccal or lower lip grafts and 17 had preputial grafts. Overall, 34 patients received buccal grafts. The median follow-up was eight years (range 1–16 years). Three patients were operated for residual chordee years later.
Results
Urethral fistulae occurred in a total of 26/100 (26.0%) cases, meatal stenosis in 16/100 (16.0%), wound breakdown in six (6.0%) and graft failure in one (1.0%). The fistula rate after the single-stage approach was 15/64 (23.4%), whereas it was 11/36 (30.6%) following two-stage repair (P = 0.4811).
Conclusions
Proximal hypospadias remains a challenging condition to treat. It is possible to perform a single-stage repair in 64.0% of cases. This brings down the median number of operations to only two. Lower lip grafts were used in 34.0% but are now used in redo-surgeries only. Our fistula rate was 26.0% but has decreased significantly in recent years.
Level of evidence
Level III.