Marzouk skin tag two-stage urethroplasty for the repair of complex cases of hypospadias

Background: Cases of hypospadias with severe chordee and deficient skin, as well as those for re-do hypospadias or fistula repair, are considered complex cases. Depending on the degree of complexity of the defect, a two-stage procedure may still be advisable. The present paper describes the so-called Marzouk skin tag urethroplasty as a new two-stage procedure advisable for use in such difficult cases. Methods: The Marzouk skin tag urethroplasty procedure was performed on 16 complex cases. The first stage consists of urethral mobilization plus the double-buttonhole procedure (designed by the author) to form a midline ventral skin tag proximal to an advanced hypospadiac orifice. This skin tag is fashioned, 6 months later, by the author's special techniques (type I in 12 patients and type II in four patients) to form the neourethral tube and its coverage with minimal dissection. Results: The operation resulted in a straight penis with neomeatus at the glans top in all 16 cases without significant complications. Both type I and II procedures give good functional results. The type I procedure has a superior cosmetic result. The follow-up period ranged from 4 to 8 months. Conclusions: The double-buttonhole modification can solve the problem of deficient skin and simplify a safe second-stage procedure. The Marzouk skin tag operation (types I and II) can be an additional option to be used when indicated.