ONE-STAGE REPAIR OF HYPOSPADIAS - IS THERE NO SIMPLE METHOD UNIVERSALLY APPLICABLE TO ALL TYPES OF HYPOSPADIAS

A simple method of hypospadias repair is described. The operative tech nique consists of 7 steps, including 1) outlining the skin incision an d dartos mobilization; 2) artificial erection, harvesting parameatal f oreskin flap and release of chordee as needed; 3) glans splitting and creation of glanular wings; 4) 1-stage urethroplasty with parameatal f oreskin flap; 5) meatal glanuloplasty; 6) creation of Byars' flaps of the skin, and 7) skin closure. Central to the technique is the feasibi lity of the choice of 1-stage urethroplasty with meatal based manta-wi ng flap or with parameatal based and fully extended circumferential fo reskin flap even after the skin incision is made, which enables its ap plication to all types of hypospadias. Of 120 patients the 1-stage ure throplasty was performed with meatal based manta-wing flap in 50, and with parameatal based and fully extended circumferential foreskin flap in 70. Primary success was obtained in 82% of the cases with meatal b ased manta-wing flap, and in 53% with parameatal based and fully exten ded circumferential foreskin flap. Complications requiring secondary r epair occurred in 42 cases (9 with meatal based manta-wing flap, and 3 3 with parameatal based and fully extended circumferential foreskin fl ap) but repair was successful in 32. Thus, the overall success rate wa s 91% (96% with meatal based manta-wing flap, and 87% with parameatal based and fully extended circumferential foreskin flap). Additional re pair (10 secondary, 2 tertiary and 1 quaternary) is planned in 13 case s. The technique of 1-stage urethroplasty with parameatal foreskin fla p is recommended as a simple and reliable treatment for hypospadias wi th a reasonable success rate.