Abstract
This review discusses means for straightening ventral curvature >30°, and then subsequent urethroplasty using either one-stage flaps or two-stage flaps or grafts. The wide variation in reported results from these various techniques makes determination of best management difficult; however, it is clear that complications for repairs done in major centers can range to ≥50 %. Given the rarity of proximal hypospadias with ventral curvature >30°, which occurs in approximately 400 newborns annually in the USA, centers should refer these cases to subspecialists within the group who can then develop and maintain expertise.
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Snodgrass W, Prieto J. Straightening ventral curvature while preserving the urethral plate in proximal hypospadias repair. J Urol. 2009;182:1720.
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Hollowell JG, Keating MA, Snyder III HM, Duckett JW. Preservation of the urethral plate in hypospadias repair: extended applications and further experience with the onlay island flap urethroplasty. J Urol. 1990;143:98.
Bush NC, DaJusta D, Snodgrass W. Glans penis width in patients with hypospadias compared to healthy controls. J Pediatr Urol. 2013;9:1188. This study measured maximum glans width in infants with distal and proximal hypospadias at median age 9 months and compared them to controls undergoing elective circumcision at median age 1 month. Mean glans widths were 14.8, 12.9 and 14.3 mm.
Braga LHP, Lorenzo AJ, Bagli DJ, Dave S, Eeg K, Forhat WA, et al. Ventral penile lengthening versus dorsal plication for severe ventral curvature in children with proximal hypospadias. J Urol. 2008;180:1743.
Castagnetti M, El-Ghoneimi. Surgical management of primary severe hypospadias in children: systematic 20-year review. J Urol. 2010;184:1469.
Zheng DC, Wang H, Lu MJ, Chen Q, Chen YB, Ren XM, et al. A comparative study of the use of a transverse prepucial island flap (the Duckett technique) to treat primary and secondary hypospadias in older Chinese patients with severe chordee. World J Urol. 2013;31:965.
Shukla AR, Patel RP, Canning DA. The 2-stage hypospadias repair: is it a misnomer? J Urol. 2004;172:1714.
Aoki K, Fujimoto K, Yoshida K, Hirao Y, Ueoka K. One-stage repair of severe hypospadias using modified tubularized transverse preputial island flap with V-incision suture. J Pediatr Urol. 2008;4:438.
Retik AB, Bauer SB, Mandell J, Peters CA, Colodny A, Atala A. Management of severe hypospadias with a 2-stage repair. J Urol. 1994;152:749.
McNamara ER, Schaeffer AJ, Seager CM, Rosoklija I, Retik AB, Diamond DA et al. Management of proximal hypospadias with 2-stage repair: 20 year experience. J Urol. 2015. e-pub. 2-stage Byars flaps repair resulted in complications in somewhere between 80% (total complications) and 49% (reoperations).
Stanasel I, Le HK, Bilgutay A, Roth DA, Gonzales ET Jr, Janzen N et al. Complications following staged hypospadias repair using transposed prepucial skin flaps. J Urol. 2015. e-pub. Complications occurred in 68 % of patients after Byars flaps repair.
Yang T, Zou Y, Zhang L, Su C, Li Z, Wen Y. Byars two-stage procedure for hypospadias after urethral plate transection. J Pediatr Urol. 2014;10:1133. This large series reported only 12% complications after Byars flap repair.
Hutton KAR, Babu R. Normal anatomy of the external urethral meatus in boys: implications for hypospadias repair. BJU Int. 2007;100:161.
Gershbaum MD, Stock JA, Hanna MK. A case for 2-stage repair of perineoscrotal hypospadias with severe chordee. J Urol. 2002;168:1727.
Devine Jr CJ. Chordee and hypospadias. In: Glenn J, Boyce W, editors. Urologic surgery. Philadelphia: JP Lippincott; 1983. p. 775.
Snodgrass W, Bush N. Outcomes of 2-stage graft repair for proximal hypospadias with >30° ventral curvature: modified glansplasty reduces glans dehiscence. ESPU abstract. 2015.
Snodgrass W, Bush N. Tubularized incised plate proximal hypospadias repair: continued evolution and extended applications. J Pediatr Urol. 2011;7:2.
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Warren Snodgrass and Nicol Bush each declare no potential conflicts of interest.
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Snodgrass, W., Bush, N. Surgery for Primary Proximal Hypospadias with Ventral Curvature >30°. Curr Urol Rep 16, 69 (2015). https://doi.org/10.1007/s11934-015-0543-5
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DOI: https://doi.org/10.1007/s11934-015-0543-5