Comparison for Duckett combining with Duplay technique and Koyanagi technique in one-staged repair for severe hypospadias

Abstract

Objective To Compare the clinical efficacy of Duckett combining with Duplay technique and Koyanagi technique for severe hypospadias in one-staged repair and to investigate the advantages and disadvantages of each technique.Methods Clinical data of 205 patients who underwent either procedure between October 2001 and June 2012 were reviewed retrospectively.Of the 205 patients,108 underwent Duckett combining with Duplay technique repair,whereas 97 were treated by Koyanagi technique.Results In the Duckett combining with Duplay technique group,there were 32 patients with perineal hypospadias and 76 with scrotal hypospadias.Fistula was noted in 11 patients (10.1％) postoperatively.Anastomotic stricture occurred in 6 cases (5.6％) and meatal stricture associated with the formation of diverticulum occurred in 3 cases (2.8％).The length of reconstructed urethral was 3.5 to 10 cm,with 5.8 cm of average.In Koyanagi technique group,there were 51 patients with perineal hypospadias and 46 with scrotal hypospadias.Twelve (12.4％) patients had postoperative fistula.Split of glans and urethra in penile forepart developed in 4 cases (4.1％).The length of reconstructed urethral was 3.0 to 7.0 cm,with 5.2 cm on average.Follow-up period was more than 3 months.Penile appearance and urethral function were satisfactory.Scrotum bifida was corrected.The incidence of total postoperative complications was not significantly difference (P＞0.05).Conclusions Both Duckett combining with Duplay technique and Koyanagi technique are common methods in one-staged repair for severe hypospadias with satisfactory therapeutic effects.The former technique is more suitable for patients with well-developed foreskin and mild penile curvature.The main post-operative complications are fistula and meatal stricture.Koyanagi technique is more suitable for patients with poorly developed foreskin and severe penile curvature,accompanied by penoscrotal transposition.It could be more effective to decrease the incidence of meatal stricture.The main postoperative complications of Koyanagi technique are fistula and distal urethral dehiscence. Key words: Hypospadias; Urologic surgical procedures; Child; Case-control studies