Proximal hypospadias. Comparative evaluation of staged urethroplasty (modified Thiersch Duplay followed by Mathieu) and single stage on-lay island flap repair.

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 pounds +/- 220 vs. 3,753.5 pounds +/- 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.