Abstract
Great advances have been made in surgery for the correction of hypospadias. Proximal hypospadias remains the greatest challenge, but, despite many innovations and much progress, surgery can fail. Many authorities have introduced single-stage techniques, which have the purported advantage of correcting the defect with minimal hospitalization and family inconvenience. However, the wider published experience with these approaches would suggest that the ideal single-stage procedure has yet to be devised. A substantial number of children undergoing a single-stage procedure will have to undergo further surgery. A small, but irreducible number of patients will be rendered hypospadias “cripples.” A number of these children will be dissatisfied as adults because of cosmetic or functional deficiencies. A two-stage approach for correction of proximal hypospadias and severe chordee remains the most credible and reliable solution for many of these patients. Pediatric urologists should maintain familiarity with these techniques and continue to advocate them for a select group of patients.
Similar content being viewed by others
References and Recommended Reading
Johnson D, Coleman DJ: The selective use of a single-stage and a two-stage technique for hypospadias correction in 157 consecutive cases with the aim of normal appearance and function. Br J Plast Surg 1998, 51:195–201.
Hodgson NB: A one-stage hypospadias repair. J Urol 1970, 104:281–283.
Devine CJ, Horton CE: A one-stage hypospadias repair. J Urol 1961, 85:166–172.
Duckett JW: Transverse preputial island flap technique for repair of severe hypospadias. Urol Clin North Am 1980, 7:423–430.
Duckett JW: The island flap technique for hypospadias repair. Urol Clin North Am 1981, 8:503–511.
Montfort G, Bretheau D, di Benedetto V, Bankole R: Posterior hypospadias repair: a new technical approach. Eur Urol 1992, 22:137–141.
Montfort G, di Benedetto V, Mayrat BJ: Posterior hypospadias: the French operation. Eur J Pediatr Surg 1995, 5:352–534.
Mollard P, Mure PY: Proximal hypospadias [in Spanish]. Arch Esp Urol 1998, 51:551–559.
Vandersteen DR, Husmann DA: Late-onset recurrent penile chordee after successful correction at hypospadias repair. J Urol 1998, 160:1131–1133. This is one of the few series to detail late-onset chordee after onestage hypospadias repair.
Romagnoli G, De Luca M, Faranda F, et al.: One-step treatment of proximal hypospadias by autologous graft of cultured urethral epithelium. J Urol 1993, 150:1204–1207.
Hensle TW, Kearney MC, Bingham JB: Buccal mucosa grafts for hypospadias surgery: long-term results. J Urol 2002, 168:1734–1737.
Metro MJ, Wu HY, Snyder HM III, et al.: Buccal mucosal grafts: lessons learned from an 8-year experience. J Urol 2001, 166:1459–1461.
Valla JS, Takvorian P, Dodat H, et al.: Single-stage correction of posterior hypospadias (178 cases): comparison of three techniques: free skin graft, free bladder mucosal graft, transverse pedicle graft. Eur J Pediatr Surg 1991, 1:287–290.
Elbakry A: Management of urethrocutaneous fistula after hypospadias repair: 10 years’ experience. BJU Int 2001, 88:590–595.
Demirbilek S, Kanmaz T, Aydin G, Yucesan S: Outcomes of one-stage techniques for proximal hypospadias repair. Urology 2001, 58:267–270.
Elbakry A: Complications of the preputial island flap-tube urethroplasty. BJU Int 1999, 84:89–94.
Ghali AM: Hypospadias repair by skin flaps: a comparison of onlay preputial island flaps with either Mathieu’s meatalbased or Duckett’s tubularized preputial flaps. BJU Int 1999, 83:1032–1038.
MacGillivray DM, Shankar KR, Rickwood AM: Management of severe hypospadias using Glassberg’s modification of the Duckett repair. BJU Int 2002, 89:101–102.
Powell CR, McAleer I, Alagiri M, Kaplan GW: Comparison of flaps versus grafts in proximal hypospadias surgery. J Urol 2000, 163:1286–1289.
Wiener JS, Sutherland RW, Roth DR, Gonzales ET Jr: Comparison of onlay and tubularized island flaps of inner preputial skin for the repair of proximal hypospadias. J Urol 1997, 158:1172–1174.
Sauvage P, Becmeur F, Geiss S, Faith C: Transverse mucosal preputial flap for repair of severe hypospadias and isolated chordee without hypospadias: a 350-case experience. J Pediatr Surg 1993, 28:435–438.
Ghali AMA, el-Malik EMA, al-Makli T, Ibrahim AH: One-stage hypospadias repair: experience with 544 cases. Eur Urol 1999, 36:436–442.
Hayashi Y, Sasaki S, Kojima Y, et al.: One-stage repair of moderately severe hypospadias using a transverse preputial tubularized island flap. Int J Urol 2001, 8:165–170.
Rickwood AM, Anderson PA: One-stage hypospadias repair: experience of 367 cases. Br J Urol 1991, 67:424–428.
Chen S, Wang G, Wang M: Modified longitudinal preputial island flap urethroplasty for repair of hypospadias: results in 60 patients. J Urol 1993, 149:814–816.
Kumar MVK, Harris DL: A long-term view of hypospadias repaired by split preputial flap technique (Harris). Br J Plast Surg 1994, 47:236–240.
Chin TW, Liu CS, Wei CF: Hypospadias repair using a double onlay preputial flap. Pediatr Surg Int 2001, 17:496–498.
Samuel M, Capps S, Worth A: Proximal hypospadias: comparative evaluation of staged urethroplasty (modified Thiersch Duplay followed by Mathieu) and single stage on-lay island flap repair. Eur Urol 2001, 40:463–468.
Sorber M, Feitz WF, de Vries JD: Short- and mid-term outcome of different types of one-stage hypospadias corrections. Eur Urol 1997, 32:475–479.
Koyanagi T, Nonomura K, Kakizaki H, et al.: Experience with one-stage repair of severe proximal hypospadias: operative technique and results. Eur Urol 1993, 24:106–110.
Koyanagi T, Nonomura K, Yamashita T, et al.: One-stage repair of hypospadias: Is there no simple method universally applicable to all types of hypospadias? J Urol 1994, 152:1232–1237.
Sugita Y, Tanikaze S, Yoshino K, Yamamichi F: Severe hypospadias repair with meatal based paracoronal skin flap: the modified Koyanagi repair. J Urol 2001, 166:1051–1053.
Emir H, Jayanthi VR, Nithara K, et al.: Modification of the Koyanagi technique for single stage repair of proximal hypospadias. J Urol 2000, 164:973–976.
Hayashi Y, Kojima K, Mizuno A, et al.: The modified Koyanagi repair for severe proximal hypospadias. BJU Int 2001, 87:235–238.
Glassberg KI, Hansbrough F, Horowitz M: The Koyanagi-Nonomura 1-stage bucket repair of severe hypospadias with and without penoscrotal transposition. J Urol 1998, 160:1104–1107.
Snodgrass WT, Lorenzo A: Tubularized incised-plate urethroplasty for proximal hypospadias. BJU Int 2002, 89:98–100.
Palmer LS, Palmer JS, Franco I, et al.: The “long Snodgrass”: applying the tubularized incised plate urethroplasty to penoscrotal hypospadias in 1-stage or 2-stage repairs. J Urol 2002, 168:1748–1750.
Ozgok Y, Ozgur Tan M, Kilciler M, et al.: Use of bladder mucosal graft for urethral reconstruction. Int J Urol 2000, 7:355–360.
Schnapka J, Mildenberger H: Urethral reconstruction using an autologous bladder mucosal graft. Eur J Pediatr Surg 1991, 1:180–182.
Duckett JW, Coplen D, Ewalt D: Buccal mucosal urethral replacement. J Urol 1995, 153:1660–1663.
Riccabona M: Reconstruction or substitution of the pediatric urethra with buccal mucosa: indications, technical aspects, and results. Tech Urol 1999, 5:133–138.
Greenfield SP, Sadler BT, Wan J: Two-stage repair for severe hypospadias. J Urol 1994, 152:498–501.
Horton CE Jr, Gearhart JP, Jeffs RD: Dermal grafts for correction of severe chordee associated with hypospadias. J Urol 1993, 150:452–455.
Khan U, Zic R, Boorman J: Waterproofing in hypospadias: a refinement of the two-stage reconstruction. Br J Plast Surg 2001, 54:528–531. This article describes one version of two-stage hypospadias repair.
Retik AB, Bauer SB, Mandell J, et al.: Management of severe hypospadias with a 2-stage repair. J Urol 1994, 152:749–751.
Samuel M, Capps S: Staged proximal hypospadias repair: modified Thiersch Duplay with midline incision in urethral plate followed by Mathieu urethroplasty. J Pediatr Surg 2002, 37:104–107.
Svensson H, Reychman M, Troeng T, Aberg M: Staged reconstruction of hypospadias with chordee: outcome and costs. Scan J Plast Reconstr Surg Hand Surg 1997, 31:51–55.
Titley OG, Bracka A: A 5-year audit of trainees experience and outcomes with two-stage hypospadias surgery. Br J Plast Surg 1998, 51:370–375.
Bracka A: A versatile two-stage hypospadias repair. Br J Plast Surg 1995, 48:345–352.
Telfer JR, Quaba AA, Kwai Ben I, Peddi NC: An investigation into the role of waterproofing in a two-stage hypospadias repair. Br J Plast Surg 1998, 51:542–546.
Gershbaum MD, Stock JA, Hanna MK: A case for 2-stage repair of perineoscrotal hypospadias with severe chordee. J Urol 2002, 168:1727–1729. This controlled assessment of the outcome in two groups undergoing repair demonstrated a higher complication rate in long-term followup after a single-stage repair.
Mureau M: Psychosexual and Psychosocial Adjustment of Hypospadias Patients. Molenaarsgraaf, The Netherlands: Optima Druk; 1995.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Greenfield, S.P. Two-stage repair for proximal hypospadias: A reappraisal. Curr Urol Rep 4, 151–155 (2003). https://doi.org/10.1007/s11934-003-0043-x
Issue Date:
DOI: https://doi.org/10.1007/s11934-003-0043-x