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.

Sweet RA, Schrott HG, Kurland R, et al: Study of incidence of hypospadias in Rochester, Minnesota 1940–1970, and a case control comparison of etiological factors. Mayo Clin Proc 1974;49:52–56.
Asopa HS: Newer concepts in the management of hypospadias and its complications. Ann R Coll Surg Engl 1998;80:161–168.
Parsons KF, Abercrombie GF: Transverse preputial island flap neo–urethroplasty. Br J Urol 1982;54:745–747.
Duckett JW: Transverse preputial island flap technique for repair of severe hypospadias. Urol Clin N Am 1980;7:423–431.
Duckett JW: The current hype in hypospadiology. Br J Urol Int 1995;76:1–7.
Frey P, Bianchi A: One stage preputial pedicle flap repair for hypospadias: experience with 100 patients. Prog Pediatr Surg 1989;23:181– 191.
El–Kasaby AW, El–Beialy H, El–Halaby R, Nowier A, Maged A: Urethroplasty using transverse penile island flap for hypospadias. J Urol 1986;136:643–644.
Mouriquand PDE, Persad R, Sharma S: Hypospadias repair: Current principles and procedures. Br J Urol Int 1995;76(suppl 3):9–22.
Secrest CL, Jordan GH, Winslow BH, Horton CE, McCraw JB, Gilbert DA, Devine CJ Jr: Repair of the complications of hypospadias surgery. J Urol 1993;150:1415–1418.
Bracka A: Hypospadias repair: The two–stage alternative. Br J Urol Int 1995;76(suppl 3):31– 41.
Uygur MC, Ersoy E, Erol D: Analysis of meatal location in 1,244 healthy men: Definition of the normal site justifies the need for meatal advancement in pediatric anterior hypospadias cases. Pediatr Surg Int 1999;15: 119–120.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.