One-stage hypospadias repair - Experience with 544 cases

Purpose: We evaluated one-stage hypospadias repairs in providing a normal looking penis with a normal functioning urethra. Also we looked critically at the effects of the severity of hypospadias, the type of repair and the experience of the surgeon on the outcome. Materials and Methods: From 1987 to 1996 we performed 578 primary hypospadias repairs. The type and surgical results as well as the effects of certain variables on outcome were reviewed retrospectively. Results: 544 single-stage hy pospadias repairs have been followed up for a mean of 19 months (range 12-49). They included: MAGPI (92), ARAP (78), Mathieu (205), Mustarde (12), Duckett's tubularized preputial flap (142) and Onlay preputial flap (15). Despite an initial overall complication rate of 19%, the final success rate was 96%, after a mean of 1.3 procedures. Complications included fistula in 48 (9%) cases, meatal stenosis or retraction in 28 (5%), residual chordee in 17 (3%), stricture in 14 (2.5%), tubal abnormality in 10 (2%), and flap necrosis in 9 (2%). Complication rates were significantly higher (p < 0.05) when the meatus was proximal, the degree of chordee was moderate or severe and in the early series. Complication rates were also significantly higher with flap procedures and when the urethral plate was resected. Cosmetic defects occurred mainly with meatal advancement procedures. Conclusions: A repertoire of different types of single stage procedures has allowed the successful treatment of most hypospadias cases presenting to one surgeon. Complication rates increases with the severity of hypospadias or transection of the urethral plate. A cumulative experience allows for better results via a proper selection of the procedure and a perfection of a few techniques.