Surgical Outcome of 59 Cases with Proximal Hypospadias

Choi, Woen Ho; Shin, Ki Yong; Woo, Young Nam

Abstract

We evaluated the clinical outcome of surgical repairs for 59 patients with proximal hypospadias with chordee. Out of 59 cases, there were 6 cases with proximal penile type, 39 with penoscrotal type, 11 with scrotal type and 3 with perineal type. Associated anomalies were bifid scrotum in 21, penoscrotal transposition in 17, cryptorchidism in 12, imperforated anus in 2 and congenital heart disease in 2 cases. Thirty-nine cases were treated with one-stage repair and 20 cases with multi-stage repair. Surgical methods for one-stage repair were transverse preputial flap (TPF, 30 cases), onlay island flap (OIF, 8 cases) and bladder mucosa graft (1 case). And surgical methods for multi-stage repair were Belt-Fugua method (11 cases), Thiersch-Duplay method (4 cases), bladder mucosa graft (3 cases) and scrotal-penile tube graft (2 cases). The overall complication rate was 40.7%. The most common complications were urethrocutaneous fistula (17 cases) and urethral stricture (7 cases). Complication rates of one-stage and multi-stage operations were 35.9% and 50%, respectively. In our series, there were 24 cases whose penile length was shorter than 2.5 cm. Out of these patients, 14 cases recieved 25 mg of testosterone cypionate at intervals of 3 weeks for a total period of three months preoperatively. Although testosterone provided some increment of penile size, postoperative complications were developed in 7 patients of testosterone-treated group exclusively. Despite relatively high complication rate in our series, our final results based on cosmesis and function were excellent in all cases. Our experience indicates that multi-stage operation may not be superior to one-stage procedure in proximal hypospadias repair, and that preoperative administration of testosterone may not decrease complication rate in cases with short penile length.