Bracka’s staged repair of proximal hypospadias - revisiting a versatile technique

Abstract

ObjectiveProximal hypospadias is associated with poorly defined urethral plate and often with chordee. A two-staged Bracka’s repair is reproducible and has been used routinely in our practice. We present the key steps of this technique on a 13-month-old boy. Patient and methodThis boy presented with proximal penile hypospadias, hooded foreskin and mild chordee. He underwent stage one Bracka’s repair. The steps included: 1) Artificial erection test to define extent of chordee; 2) inner preputial graft harvest and preparation; 3) glans and urethral plate incision down to corpora cavernosa; 4) partial release of chordee by division of aberrant corpus spongiosum, without degloving of penile skin; 5) laying of preputial graft; 6) dressing. ResultThe patient had catheter removed on second, and dressing removed on seventh, post-operative days, without complication. The patient is planned for second stage repair in 6 months. Our standard approach includes either removal of catheter on the second or seventh post-operative day, according to surgeon preference. The three senior surgeons have used this method in 54 patients without significant complication. The graft has taken in 100% of cases. ConclusionThe Bracka’s staged repair of proximal hypospadias is a versatile technique that gives reproducible and sound results.