Staged repair of proximal hypospadias: Reporting outcome of staged tubularized autograft repair (STAG)
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In brief
In brief
Case series of 43 children with proximal hypospadias treated with staged tubularized autograft repair (STAG) demonstrates 72.9% success rate after mean 3.2-year follow-up. The technique achieves effective penile straightening and urethral reconstruction, though urethrocutaneous fistula (21.6%) and glanular dehiscence (24.3%) remain primary complications requiring additional procedures.
Written by the GCMD Library team from the article.
Abstract
Introduction
Proximal hypospadias (PPH) repair is a challenge. Dilemma exists whether to do it in single or staged repair. Staged repair is our adopted procedure which was recently modified by Snodgrass into staged tubularized autograft repair (STAG), in which attention was given to ventral straightening of the penis together with some other technical details. Herein, we report our experience with STAG in a cohort of primary posterior hypospadias.
Patients and methods
In the period from 2011 to 2018 we operated 43 primary posterior hypospadias. Two principal surgeons (HB, MY) and multiple assistants operate children the same way, and data are recorded in a prospectively designed data base. In all children, inner prepuce graft was utilized, when curvature is more than 30 degrees, plate transection with or without ventral corporotomies were adopted.
Results
Forty-three children with PPH and ventral curvature more than 30 degrees underwent first stage with median age 12 months (6–132 IQR16). Penile curvature was corrected by plate transection in 27 children (62.8%), ventral corporotomies in 16 children (37.2%). Graft take was successful in 90.7%, 4 children needed revision of fibrotic graft. Second stage was completed in 37 children, success was 56.8%, 21.6% fistula, 24.3% glanular dehiscence. Overall success after third surgery to correct complications was 78.4%. In a mean follow up of 3.2 years, we had recurrence of curvature in 2 children taking success rate to 72.9%. No meatal stenosis, no diverticulum, no stricture, no urethral dehiscence was encountered. Cosmetic appearance was excellent in follow up.
Conclusion
STAG achieves proper straightening of the penis and allows for reconstruction of a good urethra, yet urethrocutaneous fistula and glanular dehiscence remain the main complications. Follow up is important to address results of ventral corporotomies.
Type of study
Therapeutic.
Level of evidence
Level IV case series with no comparison group.