Video presentation of the second stage of a two-stage repair for proximal hypospadias: a safe and reproducible technique

Abstract

Objective: The aims of proximal hypospadias repair are good cosmetic outcomes with low rates of complication, with a low number of operative exposures, before the age of genital difference realisation. Neo-urethral fistula and stenosis are well recognised complications; with international rates of 3.8-16% and 1.3-15.6% respectively. We present the key steps of the second of a two staged repair in video format.

Method: Video recording of the procedure performed on an 18-month-old with mid-penile hypospadias is presented. The steps are described; the importance of tension free tubularisation, layered urethral closure, suture technique, vascularised prepucal graft technique, optimal glanuloplasty, and penile shaft skin repair are highlighted.

Result: The child was brought back to the day ward for catheter removal at 7 days; follow-up in clinic showed good postoperative appearance. This technique has been performed on 31 boys with a fistula rate and stenosis rate favourable to the literature.

Conclusion: We demonstrate a two-stage technique by video format for proximal hypospadias which is reproducible and gives results comparable to the literature.

Keywords: Braka stage 2; Proximal hypospadias; Second-stage repair.