Two Stages repair of proximal hypospadias: Review of 33 cases

Background/Purpose: Proximal hypospadias with chordee is the most challenging variant of hypospadias to reconstruct. During the last 10 years, the approach to sever hypospadias has been controversial. Materials & Methods: During the period from June 2002 to December 2009, I performed 33 cases with proximal hypospadias, at Demerdash hospital; Ain Shams University; department of paediatric surgery. Data were collected retrospectively and included patient's age at operation, degree of the hypospadias, degree of associated chordee, the procedure performed complications and any repeated operation. All patients underwent 2 staged procedures with 9 to 12 month interval in-between. Results: Thirty three patients with proximal hypospadias were operated upon in a period of 7 years. Byars's 2 staged operation was used in all 33 cases. All patients had 2 staged repairs. Neither complete disruption nor urethral diverticula occurred in the 33 patients. Twenty four patients had no complication. Single fistula was present in 6 patients . Two patients had 2 fistulas; one at the original site of the hypospadias and the other was sub-coronal. The last patient had moderate meatal stenosis, which was successfully treated by repeated dilatations. Conclusion: Two Stages procedure using the principles of Byars's technique; is a versatile operation that can be used for the proximal hypospadias. It decreases the rate of fistula formation; disruption; stenosis and gives a satisfactory cosmetic appearance. Index Word: proximal hypospadias, two stages repair.