Is the Koyanagi Urethroplasty an Acceptable Alternative for Proximal Hypospadias

Abstract Purpose The 4 most common surgical techniques currently used for severe hypospadias (proximal division of the corpus spongiosum) are the Onlay urethroplasty, the buccal graft urethroplasty, the Bracka procedure, the Koyanagi procedure and its variants. We report our experience of the original Koyanagi in 21 cases. Material and Methods We reviewed 21 patients who had a Koyanagi urethroplasty with a mean follow-up of 13 months (6-21 months). All had a preoperative testosterone stimulation. All received the original Koyanagi procedure by the same surgeon. Technical aspects are detailed. Results Partial urethral dehiscence was found in 47.6%; fistulae in 19%; urethrocele in 19%; meatal stenosis in 14.3%. Up to now, 57% required further surgical attention i.e. 1.6 operations per patient. Cosmetic results were found good by parents and doctors with a respective score of 13.4/20 and 14/20. Urine stream was found satisfactory in 86% cases and too narrow in 14%. Conclusions The redo-operation rate of the Koyanagi procedure is comparable to buccal graft urethroplasty but much greater than the Onlay urethroplasty. Modified Koyanagi (button hole) might provide a lower complication rate. Parents should be warned that most patients who received this type of urethroplasty are likely to receive 2 or more procedures to achieve a satisfactory result. Preoperative hormonal preparation of the penis is likely to be a key issue in the healing capacity of the tissues.