Proximal hypospadias - Comparative evaluation of staged urethroplasty (Modified thiersch duplay followed by mathieu) and single stage on-lay island flap repair

Objectives: Comparative analysis of functional results, complications, cosm esis, operative time and hospital stay between staged urethroplasty and sin gle-stage on-lay island flap for proximal hypospadias. Materials and Methods: Non-randomised single observer study of two groups o f patients over a 5-year period with proximal hypospadias. Group 1 had 17 p atients (mean age 17.7 +/- 1.6 months) who underwent a staged urethroplasty . Urethral plate was tubularised and proximal hypospadias converted to a di stal hypospadias. Hooded dorsal prepuce was buttonholed and transposed vent rally to cover the neo-urethra. Subsequently a parameatal based flip flap u rethroplasty completed urethral reconstruction. Group 2 had 17 patients (me an age 18.2 +/- 2.2 months) with a single stage inner preputial on-lay isla nd flap based on superficial dorsal vessels. Results: Mean period of follow-up has been 2.8 +/- 1.7 years in group 1 vs. 3.2 +/- 1.6 years in group 2 (p = 0.2). In both groups (34), 79% of the ch ildren who are now toilet trained and standing to void have a good calibre straight single stream of urine in a forward direction (p = 1.00). Main com plication seen in both groups was urethrocutaneous fistulae: 6% (1/17) in g roup 1 vs. 59% (10/17) in group 2 (p = 0.0002). In both groups (34) cosmeti c appearance of a natural vertical slit glanular meatus situated at the nor mal position on the glans was achieved (p = 1.00). Total mean duration of o perative time in group 1 was 193.5 +/- 42.9 vs. 203 +/- 27.6 min in group 2 (p = 0.24). Total mean duration of hospital stay in group 1 was 3.4 +/- 0. 6 vs. 9.2 +/- 2.9 days in group 2 (p = 0.0001). Total mean cost of the proc edure in group 1 was pound 2,347.3 +/- 220 vs. pound 3,753.5 +/- 75 in grou p 2 (p = 0.002). Conclusion: Staged urethroplasty for proximal hypospadias results in a norm al penis with good function, minimal complications and excellent cosmesis. Hospital stay was shorter and overall cost lower than a single stage on-lay island flap urethroplasty. Copyright (C) 2001 S. Karger AG, Basel.