Objectives: Comparative analysis of functional results, complications, cosmesis, operative time and hospital stay between staged urethroplasty and single–stage on–lay island flap for proximal hypospadias. Materials and Methods: Non–randomised single observer study of two groups of patients over a 5–year period with proximal hypospadias. Group 1 had 17 patients (mean age 17.7±1.6 months) who underwent a staged urethroplasty. Urethral plate was tubularised and proximal hypospadias converted to a distal hypospadias. Hooded dorsal prepuce was buttonholed and transposed ventrally to cover the neo–urethra. Subsequently a parameatal based flip flap urethroplasty completed urethral reconstruction. Group 2 had 17 patients (mean age 18.2±2.2 months) with a single stage inner preputial on–lay island 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 children 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 complication seen in both groups was urethrocutaneous fistulae: 6% (1/17) in group 1 vs. 59% (10/17) in group 2 (p = 0.0002). In both groups (34) cosmetic appearance of a natural vertical slit glanular meatus situated at the normal position on the glans was achieved (p = 1.00). Total mean duration of operative 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 procedure in group 1 was £ 2,347.3±220 vs. £ 3,753.5±75 in group 2 (p = 0.002). Conclusion: Staged urethroplasty for proximal hypospadias results in a normal 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.

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