Staged Tubularized Autograft Repair for Primary Proximal Hypospadias with 30-Degree or Greater Ventral Curvature

Abstract

We report outcomes in consecutive patients with primary proximal hypospadias and ventral curvature 30 degrees or greater after degloving, all repaired with 2-stage tubularized autografts, a variation of the Nicolle-Bracka procedure. Consecutive boys with proximal hypospadias and ventral curvature 30 degrees or greater after degloving underwent transection of the urethral plate. In addition, those with persistent ventral curvature 30 degrees or greater underwent 3 ventral corporotomies without corporal grafting for straightening. Staged graft urethroplasty was performed using prepuce, or labial mucosa, when the family requested preputioplasty. The goal in all cases was a straight penis with a normally positioned neomeatus. A total of 43 boys completed both stages with postoperative followup. Mean ventral curvature was 70 degrees, which necessitated corporotomy in 65%. There was no recurrent ventral curvature. Preputial grafts were used in 88%. A skin graft or scrotal flap was needed for ventral shaft coverage at the second stage in 4 boys (9%). During followup of an average of 22 months urethroplasty complications were diagnosed in 10 (23%), mostly glans dehiscence and fistulas. Of these patients 9 underwent 12 reoperations. Success was achieved in 42 (98%) patients. Staged tubularized autograft resulted in a straight penis with a normally positioned neomeatus in boys with the most severe proximal hypospadias in 77%, increasing to 98% after 1 or 2 distal reoperations for complications. There was no recurrent ventral curvature after 3 corporotomies without corporal grafting. Urethroplasty graft take was reliable.