“Two stages at one time” procedure: a single stage urethroplasty for severe hypospadias

Abstract

Purpose To present a video showing a procedure for severe scrotoperineal hypospadias repair that attempts to combine the advantages of a single-stage reconstruction with the safety of a two-stage procedure. Material and methods The operation originates from the Koyanagi-Nonomura technique. Its modification by Emir and the “Yoke” procedure described by Snow starts with the degloving of the penis and straightening of the shaft. A buttonhole is created in the dorsal penile skin through which glans is passed, transposing the entire foreskin ventrally. Glanular wings are created. The transposed foreskin is separated vertically in the midline. The two flaps are longitudinally sutured together in the midline and secured to the glans and to the corpora creating the tissue for the future urethral plate. A “U”shaped incision including the native urethral meatus is performed, defining the urethral plate, that is minimally detached from the lateral skin, keeping the blood supply intact, rolled into a tube and sutured in the midline. Glansplasty and coverage of the neourethra with subcutaneous tissue or vaginal flaps are next steps. Skin is approximated in the midline in a “pants over vest” fashion. Urine drainage is secured by a dripping stent.