Stage Urethroplasty Research Articles

One Stage Urethroplasty in Severe Hypospadias Using Buccal Mucosa and Longitudinal Penile Island Flap

Purpose The incorporation of the urethral plate into the neourethra is essential for a successful correction of Hypospadias. However, the quality and availability of the urethral plate is variable in severe forms of Hypospadias, thus it is often difficult to repair these using conventional methods. We present a single stage method of combining buccal mucosa and longitudinal onlay island penile flap for urethral reconstruction. Material and Methods During the period from October 2003 to June 2009, a total of 14 children with the mean age of 18 months (range 6-26 months) underwent this type of surgery. The indication was scrotal Hypospadias (n=8), perineal Hypospadias (n=4) and Hypospadias without Hypospadias (n=2). In all cases the urethral plate was too short and had to be divided. The penis is completely straightened using the Yachia technique. Longitudinal penile island flap was harvested with abundant and redundant vascularized subcutaneous tissue from dorsal penile and preputial skin. Buccal mucosa was grafted on the tunica albuginea in-between the divided parts of the urethral plate. Longitudinal vascularized skin flap was button-holed ventrally. The edges of the flap and buccal mucosa were sutured together in an onlay manner, to form the neourethra. Glans wings were reunited over the neourethra. The remaining penile skin was used to cover the penile body. Results The follow up was 2.8 years (range 3 months to 4,5 years). Good esthetic and functional results are achieved. The patients void easily through their neourethra. No fistulas or stenosis occurred. One Two children have a urethral diverticula. Conclusions Urethroplasty using buccal mucosa graft and vascularized penile skin flap represent a good choice in cases where the urethral plate is short, absent or of bad quality. The procedure has the advantage of an onlay procedure performed in a single stage.

Urethroplasty With Abdominal Skin Grafts for Long Segment Urethral Strictures

Buccal derived graft tissue has been proven to be useful in urethral reconstruction. However, nonbuccal sources are often needed for long segment strictures or for those with prior buccal harvest. We describe a technique using full-thickness abdominal skin grafts for long segment urethroplasty and present the short-term outcomes. A total of 21 men underwent urethroplasty for strictures of an average of 11 cm (range 4 to 24) using abdominal wall skin. Prior urethroplasty was performed in 52% of patients and multistage repair was conducted in 48%. The recurrence rate following urethroplasty was 19%, with 9.5% requiring revision after first stage urethroplasty. Complications included hair from the skin graft during the early part of the series (14.5%), glans dehiscence (9.5%), urethrocutaneous fistula (9.5%) and periurethral abscess (1 patient). Histological evaluation at 6 months demonstrated excellent uptake of grafts with minimal keratinization. In men with significant penile scarring, lichen sclerosis and long segment urethral strictures the use of abdominal skin limits donor site morbidity, and provides a useful alternative graft source for urethroplasty when buccal mucosa or genital skin are not available or sufficient. Grafts should be harvested from nonhair bearing areas to minimize the risk of urethral hair development.

Urethrotomy Has a Much Lower Success Rate Than Previously Reported

We evaluated the success rate of direct vision internal urethrotomy as a treatment for simple male urethral strictures. A retrospective chart review was performed on 136 patients who underwent urethrotomy from January 1994 through March 2009. The Kaplan-Meier method was used to analyze stricture-free probability after the first, second, third, fourth and fifth urethrotomy. Patients with complex strictures (36) were excluded from the study for reasons including previous urethroplasty, neophallus or previous radiation, and 24 patients were lost to followup. Data were available for 76 patients. The stricture-free rate after the first urethrotomy was 8% with a median time to recurrence of 7 months. For the second urethrotomy stricture-free rate was 6% with a median time to recurrence of 9 months. For the third urethrotomy stricture-free rate was 9% with a median time to recurrence of 3 months. For procedures 4 and 5 stricture-free rate was 0% with a median time to recurrence of 20 and 8 months, respectively. Urethrotomy is a popular treatment for male urethral strictures. However, the performance characteristics are poor. Success rates were no higher than 9% in this series for first or subsequent urethrotomy during the observation period. Most of the patients in this series will be expected to experience failure with longer followup and the expected long-term success rate from any (1 through 5) urethrotomy approach is 0%. Urethrotomy should be considered a temporizing measure until definitive curative reconstruction can be planned.

Modified Koyanagi Technique in Management of Proximal Hypospadias

Background/Purpose: One stage urethroplasty with parameatal foreskin flap (OUPF) applicable to all types of hypospadias was first described by Tomohiko Koyanagi, however high complication rates were reported .The aim of this study is to analyze the results of a modification of the Koyanagi technique as a one-stage repair of proximal hypospadias. Patients and Methods: During the period of from March 2008 to March 2009, 30 patients underwent treatment of proximal hypospadias using the modified Koyanagi technique. Patient age at the time of surgery ranged from 6 to 24 months. In all cases, the urethral opening was at or just proximal to the penoscrotal junction. Follow up ranged from 3 months to 1 year. Results: Primary success occurred in 27 cases (90%) with accepted cosmetic appearance. Complications occurred in 3 cases (10%). Urethrocutaneous fistula occurred in 2 cases (6.7%). Meatal recession occurred in 1 case (3.3%). There was no incidence of meatal stenosis, urethral stricture, residual chordee or complete flap necrosis.

Combined Endoscopic and Surgical Technique for the Repair of Posterior Traumatic Urethral Stricture

The aim of this study is to show and evaluate the combined procedure, which uses an endoscopic suprapubic access and a surgical perineal access to repair posterior urethral stricture secondary to traumatic pelvis fracture. Material and Methods In the period from January 1989 to December 2007 eighty-nine patients underwent urethral surgery for post-traumatic posterior urethral stricture. From January 2003 all patients underwent combined endoscopic and surgical technique. According to this technique, the patient is placed in simple lithotomic position with the calves carefully placed in Allen stirrups. Two surgical teams work simultaneously. A middle-line perineal incision is made and the bulbar urethra is isolated proximally and the membranous urethra is transected at the strictured site. At the same time the second surgical team performs an endoscopic suprapubic access placing the “Amplatz” sheath, previous progressive dilation to 20/22 Ch. By using a rigid or flexible cystoscope the operator follows endoscopically the bladder neck and reaches the stenotic site performing an anterograde urethroscopy. At this point the perineum is transilluminated by the endoscope and the surgeon can easily identify the proximal urethral end. A soft guide wire is inserted at this point into the urethra through the endoscope to facilitate the dilation till a nose speculum can be inserted. At this point an end-to-end anastomosis is performed. A Foley 18 Fr catheter and a suprapubic cystostomy are left in place for 1 month; a voiding cystourethrography is then performed. Results The bulboprostatic anastomosis shows better results (65% of success) if compared with the other techniques (Badenoch, two stage urethroplasty, perineal urethrostomy). A definite increase in the success rate (10%) has been evident in the last five years, simultaneously to the use of combined technique. Conclusions The combined perineal and suprapubic access, in post-traumatic posterior urethral strictures repair, allows achieving a better and easy location and a better preparation of the proximal urethra. The final target is to obtain a better bulboprostatic anastomosis, with better results confirmed by long-term follow-up. In particular, the endoscopic management of the suprapubic access is possible and of minor invasiveness to the patient.

Urethral Reconstruction in Patients With Neurogenic Bladder Dysfunction

There is limited literature examining urethral reconstruction in patients with neurogenic bladder dysfunction. We describe our experience of urethral reconstruction in men with concurrent neurogenic bladder. A prospectively maintained database of all urethral reconstruction procedures performed by 1 surgeon was analyzed for patients with neurogenic bladder dysfunction. Patient characteristics including the etiology of neurogenic bladder, urethral pathology, urethral reconstructive technique, complications and recurrences were evaluated. A total of 23 patients were included in the analysis. Urethral pathology included erosions (10), strictures (7), diverticula (3), urethrocutaneous fistulas (2), and a combination of diverticular and stricture disease (1). Median length of the urethral pathology was 5.0 cm (range 2.0 to 10.0). Overall urethral reconstruction was successful in 16 of 23 patients (69.6%) at a mean followup of 24.7 months (range 2 to 79). Success rates differed among the types of pathology with 60% for urethral erosions, 85.7% for urethral strictures, and 66.6% for urethral diverticula and fistulas. Of those cases of recurrence 4 of 7 (57%) were after urethral erosion repair. There was 1 (4.3%) postoperative complication and no patient underwent urinary diversion after recurrence. When identified at an early stage, urethral reconstruction in patients with neurogenic bladder dysfunction offers acceptable outcomes with limited morbidity. Men undergoing reconstruction for urethral erosion had inferior outcomes compared to those with other urethral pathology.

One Stage Urethroplasty with Pedicled Penile Skin Flap

One Stage Urethroplasty with Pedicled Penile Skin Flap

Long-Term Efficacy of Distal Penile Circular Fasciocutaneous Flaps for Single Stage Reconstruction of Complex Anterior Urethral Stricture Disease

We determined the overall efficacy and predictors of success of the distal penile circular fasciocutaneous flap in the management of complex anterior urethral stricture disease not due to lichen sclerosus. We performed a retrospective review of all patients undergoing reconstruction of complex anterior urethral strictures without lichen sclerosus repaired from 1985 to 2006. Primary and overall stricture-free survival curves were estimated using the Kaplan-Meier method. Cox proportional hazards regression analysis was used to identify univariate and multivariate predictors of flap success. A total of 124 patients met the inclusion and exclusion criteria. Median patient age was 48 years (range 16 to 83). Median followup was 7.3 years (range 1 month to 19.5 years). Median stricture length was 8.2 cm (range 0.5 to 24). At 1, 3, 5 and 10 years the overall estimated stricture-free survival rates were 95%, 89%, 84% and 79%, respectively. On multivariate analysis smoking (HR 4.0, 95% CI 1.2-12.9, p = 0.02), history of hypospadias repair (HR 4.4, 95% CI 1.3-14.6, p = 0.01) and stricture length 7 to 10 cm (HR 7.0, 95% CI 1.4-34.7, p = 0.02) were predictive of failure. Fasciocutaneous flap urethroplasty has good and durable success rates in the treatment of complex anterior urethral strictures. Predictors of failure included smoking, history of hypospadias repair and longer stricture length.

Buccal Mucosa Graft Urethroplasty for Anterior Urethral Stricture Repair: Evaluation of the Impact of Stricture Location and Lichen Sclerosus on Surgical Outcome

We report our experience with buccal mucosa grafts for anterior urethral strictures. We compared outcomes in the pendulous and bulbar urethra as well as the impact of lichen sclerosus on success. A total of 53 men underwent buccal mucosa graft urethroplasty from 1997 to 2004 for strictures of all etiologies, including lichen sclerosis in 13. Of the patients 46 underwent 1-stage repair and 7 with full-thickness circumferential disease underwent multistage repair. For 1-stage repair strictures were limited to the bulb in 33 cases and they involved the pendulous urethra in 13. A dorsal onlay was used in 24 cases and a ventral onlay was used in 22. For multistage urethroplasty 2 strictures were in the bulbar urethra and 5 were in the pendulous urethra. Success was defined as no postoperative procedures or complications. The success rate of all urethroplasties was 81% (43 of 53 cases) at a mean followup of 52 months. For bulbar vs pendulous urethroplasty the success rate was 86% (30 of 35 cases) vs 72% (13 of 18, p = 0.23). For 1-stage urethroplasty by graft location success was achieved in 20 of 24 cases (83%) for dorsal onlay vs 17 of 22 (77%) for ventral onlay (p = 0.61), in 18 of 21 (86%) for bulbar-dorsal onlay, in 10 of 12 (83%) for bulbar-ventral onlay, in 2 of 3 (66%) for pendulous-dorsal onlay and in 7 of 10 (70%) for pendulous-ventral onlay. For multistage urethroplasty success was achieved in 2 of 2 cases (100%) for bulbar repair vs 4 of 5 (80%) for pendulous repair. In the 13 patients with lichen sclerosus success was achieved in 4 of 8 (50%) with 1-stage repair vs 4 of 5 (80%) with multistage repair (p = 0.28). Complications developed in 10 of 53 cases (19%), including fistula in 1, urinary tract infection in 1 and stricture in 8 that required treatment, including dilation in 3, internal urethrotomy in 4 and perineal urethrostomy in 1. Five of these 8 recurrent strictures (63%) developed in patients with lichen sclerosus, including 4 in urethras in which 1-stage repair was done for lichen sclerosus. There were no donor site complications, postoperative erectile dysfunction or chordee. A buccal mucosa graft placed dorsally or ventrally remains an excellent graft material in the bulbar and pendulous urethra. When lichen sclerosus is present, careful consideration should be given to complete excision of the diseased urethra with multistage repair vs accepting a higher rate of stricture recurrence with 1-stage repair.

MP-22.03: First stage urethroplasty as a permanent solution in patients with complex anterior urethral stricture

MP-22.03: First stage urethroplasty as a permanent solution in patients with complex anterior urethral stricture

Proximal Hypospadias With Severe Chordee: Single Stage Repair Using Corporeal Tunica Vaginalis Free Graft

We report the results of corporeal tunica vaginalis free graft for single stage correction of severe chordee in children with proximal hypospadias. A total of 18 children with proximal hypospadias and severe chordee underwent tunica vaginalis free graft for correction of chordee and urethroplasty. The graft was anastomosed to the ventral surface of the corpus cavernosum to correct severe penile curvature without dorsal plication of the corpus cavernosum. Single stage urethroplasty was then performed. In cases where the urethral plate was too short for urethral reconstruction a transverse preputial island flap was used for single stage urethroplasty. If the incised urethral plate did not have a well vascularized and supple appearance or the prepuce was not sufficient for phallic coverage, we transected the urethral plate and staged urethroplasty was done. Mean followup was 27.5 months. In 13 patients ventral chordee was corrected using tunica vaginalis free graft without transecting the urethral plate, and urethroplasty was performed in 1 stage. In 3 patients the urethral plate was transected and a transverse preputial island flap was used for single stage urethroplasty. In 2 patients the urethral plate was transected and interposed with dermal graft and tunica vaginalis free graft, followed by staged urethroplasty. There was mild residual chordee in 2 cases. One child had a urethrocutaneous fistula at 2 weeks postoperatively, and 1 presented with obstructive pattern uroflowmetry due to meatal stenosis. In this preliminary report the majority of patients with proximal hypospadias and severe chordee were successfully treated with single stage repair using tunica vaginalis free graft for correction of severe chordee.

The Surgical Management of Obstructive Stents Used for Urethral Strictures

We present our referral experience with patients who had extensive urethral obstruction following UroLume insertion and were treated with urethroplasty. We retrospectively analyzed the records of 13 men with urethral stricture who experienced recurrent obstruction following placement of a UroLume endoprosthesis. In all patients several attempts at urethral dilation and optical urethrotomy failed to overcome the obstruction. Complete excision of the obstructed urethra containing the stent with the surrounding periurethral fibrosis was done in all patients. In 12 patients a 1-stage bipedicled penile island tubularized flap was used to bridge the urethral defect. In 1 patient 1-stage urethroplasty was performed and he is awaiting stage 2. Followup assessment included urine flow, post-void residual urine measurement, retrograde urethrogram and urethroscopy at different intervals. Of the 12 patients who underwent complete treatment 1 had a short segment stricture at the site of the distal anastomosis 3 months after catheter removal, which was successfully managed by internal urethrotomy. He was doing well at the 12-month followup. In 11 patients a successful outcome was noted immediately after catheter removal and it was maintained at a mean followup of 1.8 years (range 1 to 4). Complete excision of the obstructed urethra containing the UroLume stent with the surrounding periurethral fibrosis is an important first step in reconstruction. Subsequent use of a 1-stage bipedicled penile island tubularized flap resulted in excellent long-term results. In a small subset of cases delayed stage 2 repair after skin inlay is a valuable option.

111: Two Stage Urethroplasty for Complex Bulbar Urethral Strictures Utilising a Combination of Dorsal and Ventral Buccal Mucosal Grafts

111: Two Stage Urethroplasty for Complex Bulbar Urethral Strictures Utilising a Combination of Dorsal and Ventral Buccal Mucosal Grafts

Lengthening the urethral plate with a double flap or a lateral flap technique for repair of primary hypospadias with chordee: 6 year's experience

Purpose Chordee correction in moderate to severe hypospadias usually implies excision of the urethral plate to achieve adequate penile straightening. There has been an evolution of thought about conservation of the healthy urethral plate in hypospadias surgery. We present the first results with a new 1-stage procedure that achieves satisfactory penile straightening and conservation of the urethral plate. Material and methods From December 1999 to October 2006, 23 pediatric patients with primary moderate or severe hypospadias and chordee underwent this 1-stage urethroplasty. The urethral plate is divided into 2 flaps in an oblique fashion (16 patients) or with an only lateral flap (7 patients). We resect the fibrous ventral tissue after mobilization of the plate and we achieve penile straightening. The ventral side of the neo-urethra is harvested from the prepuce with an onlay island flap (18 patients) or penile skin with the Mathieu “flip-flap” procedure (5 patients). Results Mean follow up was 4.2 years (Range 0.6 to 6.8). No intraoperative complications developed during division of the plate and detethering. 8 post operative complications developed (34.7%): Urethrocutaneos fistulae developed in 6 patients, and 2 meatal retractions that required a GAP procedure. No residual curvature or urethral stricture was noted in our series. All 21 patients had excellent cosmetic results. Conclusions We believe that the lengthening of the urethral plate could be a useful procedure in select cases of primary hypospadias with severe chordee. This technique achieves satisfactory penile straightening and excellent cosmetic results, with a similar complications rate to others procedures for this anomaly.

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

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.

Y-Duplication of the Urethra: A Rare Case Report

A 21-year-old male with complete urethral duplication presented with continent voiding per rectum and only thin stream of urine from the normal meatal site on straining. Patient had a normal external meatus and an ectopic urethral opening just inside the anal verge. Retrograde urethrogram confirmed Y-duplication of the urethra. He was managed successfully with a single stage urethroplasty under a covering colostomy. We report this case because of its extreme rarity.

Anastomotic Fibrous Ring as Cause of Stricture Recurrence After Bulbar Onlay Graft Urethroplasty

We retrospectively reviewed patterns of failure after bulbar substitution urethroplasty. In particular we investigated the prevalence and location of anastomotic fibrous ring strictures occurring at the apical anastomoses between the graft and urethral plate after 3 types of onlay graft techniques. We reviewed the records of 107 patients who underwent bulbar urethroplasty between 1994 and 2004. Mean patient age was 44 years. Patients with lichen sclerosus, failed hypospadias repair or urethroplasty and panurethral strictures were excluded. A total of 45 patients underwent dorsal onlay skin graft urethroplasty, 50 underwent buccal mucosa onlay graft urethroplasty and 12 underwent augmented end-to-end urethroplasty. The clinical outcome was considered a success or failure at the time that any postoperative procedure was needed, including dilation. Mean followup was 74 months (range 12 to 130). Of 107 cases 85 (80%) were successful and 22 (20%) failed. Failure in 12 patients (11%) involved the whole grafted area and in 10 (9%) it involved the anastomotic site, which was distal and proximal in 5 each. Urethrography, urethral ultrasound and urethroscopy were fundamental for determining the difference between full-length and focal extension of re-stricture. Failures were treated with multistage urethroplasty in 12 cases, urethrotomy in 7 and 1-stage urethroplasty in 3. Of the patients 16 had a satisfactory final outcome and 6 underwent definitive perineal urinary diversion. The prevalence and location of anastomotic ring strictures after bulbar urethroplasty were uniformly distributed in after 3 surgical techniques using skin or buccal mucosa. Further studies are necessary to clarify the etiology of these fibrous ring strictures.

The Tongue as an Alternative Donor Site for Graft Urethroplasty: A Pilot Study

Urethroplasty with a buccal mucosal graft provides excellent clinical results but it may also cause oral complications in some cases. The mucosa covering the lateral and under surface of the tongue is identical in structure with that lining the rest of the oral cavity. We evaluated LMGs for urethroplasty. From January 2001 to September 2004, 8 men 34 to 65 years old (mean age 46.1) with urethral strictures 1.5 to 4.5 cm long were selected for 1-stage dorsal onlay urethroplasty. The site of the harvest graft was the lateral mucosal lining of the tongue. Postoperatively all patients were followed with urethrography, uroflowmetry, cystourethrography and flexible urethroscopy after 3 and 12 months. Successful reconstruction criteria were peak flow rate greater than 15 ml per second and no need for postoperative urethral dilation. Median followup was 18 months (mean 22.1, range 3 to 47). Seven cases were successful. One patient had a partial urethral stricture. In successful cases cystourethrography revealed no significant graft contractures or sacculations and at flexible urethroscopy LMG was almost indistinguishable from native urethra. There were no pain, esthetic or functional complications at the donor site. Harvesting the LMG is feasible and easy to perform. Compared with the buccal mucosal graft the LMG seems to be associated with less postoperative pain and a minor risk of donor site complications. These preliminary functional and esthetic data are satisfactory.

BULBAR URETHROPLASTY USING BUCCAL MUCOSA GRAFTS PLACED ON THE VENTRAL, DORSAL OR LATERAL SURFACE OF THE URETHRA: ARE RESULTS AFFECTED BY THE SURGICAL TECHNIQUE?

The use of buccal mucosa graft onlay urethroplasty represents the most widespread method of bulbar urethral stricture repair. The graft may be placed on the ventral or dorsal urethral surface according to surgeon experience and preference. We investigated whether the results are affected by the surgical technique by comparing the outcome of 3 types of bulbar urethroplasty using buccal mucosa graft. We repaired 50 bulbar urethral strictures with buccal mucosa grafts from 1997 to 2002. Mean patient age was 42 years. The etiology of stricture was ischemia in 12 cases, trauma in 6, instrumentation in 4 and unknown in 28. Patients with lichen sclerosus, failed hypospadias or urethroplasty and stricture extending into the penile urethra were not included. A total of 47 patients (94%) had undergone previous urethrotomy or dilation. The buccal mucosa graft was always harvested from the cheek using a 2 team approach. Mean graft length was 4.2 cm. The graft was placed on the ventral, dorsal and lateral bulbar urethral surface in 17, 27 and 6 cases, respectively. Clinical outcome was considered a success or failure at the time that any postoperative procedure was needed, including dilation. Mean followup was 42 months (range 12 to 76). Of 50 cases 42 (84%) were successful and 8 (16%) failed. The 17 ventral grafts provided success in 14 cases (83%) and failure in 3 (17%). The 27 dorsal grafts provided success in 23 cases (85%) and failure in 4 (15%). The 6 lateral grafts provided success in 5 cases (83%) and failure in 1 (17%). No surgical complications were observed. Failures involved the anastomotic site (distal in 2 and proximal in 3) and the whole grafted area in 3 cases. They were treated with urethrotomy in 5 cases and 2-stage urethroplasty in 3. In our experience the placement of buccal mucosa grafts into the ventral, dorsal or lateral surface of the bulbar urethra showed the same success rates (83% to 85%) and the outcome was not affected by the surgical technique. Moreover, stricture recurrence was uniformly distributed in all patients.

Surgical correction of penoscrotal transposition associated with hypospadias and bifid scrotum: our experience of two-stage repair

Objective To assess the results of surgical correction of incomplete penoscrotal transposition and bifid scrotum using the Glenn–Anderson technique, and its impact on subsequent definitive urethroplasties and final outcome. Patients and methods We retrospectively reviewed 31 children that underwent two-stage repair for incomplete penoscrotal transposition with severe hypospadias and bifid scrotum. Patient age at stage 1 ranged from 12 to 24 months (average 16 months). The operative principle was based on achieving a normal anatomical position of the penis and scrotum using the Glenn–Anderson technique. In cases with associated scrotal or perineal hypospadias this was transformed into a penoscrotal hypospadias. Final stage urethroplasty was performed after a period of 6 months with a modified Thiersch–Duplay technique. Results Cosmetic and functional results of the Glenn–Anderson operation were excellent. No major complications were observed. Of 31 patients, 12 (38%) had complications secondary to urethral repair. Conclusion The Glenn–Anderson technique for reconstruction of penoscrotal transposition and bifid scrotum is a simple technique, free of major complications. The purpose of this intervention is to improve the cosmetic appearance and function of the penis. A minimum period of 6 months between consecutive urethroplasties is important. The final stage guarantees good functional and cosmetic results preserving the prepuce.