The Recognition Of Two-stage Repair In Hypospadias

Objectives：Two-stage repair was described in the early history of surgery and wassubsequently abandoned as technical developments.But,there are still advantages insome special cases.The staged approach allows for both excellent cosmetic results anda low morbidity.Therefor，two-stage repair to return to the stage of history in recentyears.A retrospective review of102patients who had staged approach for the Severeprimary repair of hypospadias at the Genernal Hospital of GuangZhou MilitaryCommand was performed to objectively assess the clinical outcomes of thistechnique.Methods：Between march2008and september2011,102patients underwent atwo-stage reconstruction for Severe primary hypospadias. Indications for staged repairincluded. The position of the meatus was posterior(glanular (n=0),(sub)coronal (n=0),distal penile (n=18)) in18patients (17.6%), middle(midshaft (n=34)) in34(33.3%) and distal (proximal penile (n=20),penoscrotal (n=27),scrotal (n=3),perineal (n=0)) in50(49.1%) according to Barcatclassification. moderate orsevere chordee (102patients), poor glans groove, and lichen sclerosis(15patients).The severity of chordee was graded into0-4according to the etiological classificationon congenital chordee. Median age was5.3years old (8months to25years).Hypospadias postoperative patients routine urinary diversion8-14days(median13days) and median follow-up was16months.Results：All patients showed excellent cosmetic results with urethral meatus on thetwo-stage repair.The first-stage of the operation average time was85±25.0min and the second-stage was135.4±20.0min.No complications occurred after the firststage;No cases of residual chordee were detected,whereas postoperative urethralstenosis occurred in2(1.9%)cases of the external urethral orifice after the secondstage,which healed after2weeks by local incision of the external urethral orifice.Allten (10.8%) of these patients had the complication of urethrocutaneousfistula,Including three cases in Coronal,one case in midshaft,six parents inpenoscrotal,which healed after6moths by Urinary fistula repair.One cases (1.0%) ofthe new urethra after dehiscence that required reoperation.Most of the patientspresented terminal meatus, no chordee, no urethral stricture and normal voiding.Conclusions：The staged repair is a safe and reliable approach in selected patients inwhom the urethral plate cannot be incorporated in the repair and thus requiressubstitution. These include both primary hypospadias with severe curvature, complexredo cases, and cases with BXO,particularly suitable for severe chordee (more than40°) caused by urethral tethering. What is more,the results are irrespective ofhypospadiac meatal position and surgical age,the Results of the staged proceduresand TIP with no significant statistically difference.Coverage of the neourethra with asecond layer usingvarious vascularized flaps has decreased the rate ofurethrocutaneous fistulae,four kinds of coverage was no significant difference in theurinary fistula rate.Complication of urinary diversion are reduced by modified methodcompared with3tube method.