The two-stage urethroplasty with distal urethral preset for proximal pediatric hypospadias

Abstract

Objective To investigate retrospectively a modified procedure of two-stage urethroplasty with distal urethral preset for proximal pediatric hypospadias and evaluate the feasibility and advantages of the method. Methods From January 2013 to January 2018, two-stage urethroplasty with distal urethral preset was performed in 36 boys from 19 months to 15 years old (median age 36 months) with proximal hypospadias. The penile straightening and distal urethroplasty were performed at the first stage, meanwhile, the original urethral opening was preserved. After the distal reconstructed urethra performed in 6 months, the neourethra was connected with proximal meatus to re-establish the continuous urethra. The wound infection, urinary leakage, urethral stricture, appearance of penis and urination were observed after the second stage operation. Results One case had skin infection around the wound after first stage operation and healed after wound management. Another one case had the distal urethra dehiscence but the wound has no signs of infection. The child had moderate anemia, and the hemoglobin is 80 g/L.It was therefore considered that anemia was the cause. The hemoglobin level was normal during the second stage operation, and repaired by Snodgrass method in the second stage. Five cases had the balanue dehiscence.Thirty case had being succeeded after the first stage, included a case of wound infection 5 days after operation. Three cases developed urethral fistula after the second stage repair, which were mended in the third stage. At a mean follow-up of 20 months postoperatively (14 to 48 months), all patients had satisfied appearance of penis, unobstructed urination and continuous urine line, without urinary fistula, urethral stricture and urethrocele at the second stage repair. Conclusions The distal urethral preset and staged procedure is a feasible operation that corrects proximal hypospadias with few complications and with good cosmetic and functional outcomes. Key words: Hypospadias; Surgical flaps; Reconstructive surgical procedures