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S14-7
(PP)
2-STAGE GRAFT REPAIR FOR PROXIMAL HYPOSPADIAS WITH >30° VENTRAL
CURVATURE: MODIFICATION TO IMPROVE OUTCOMES
Warren SNODGRASS and Nicol BUSH
PARC Urology, Dallas, USA
PURPOSE
Few articles report outcomes from 2-stage primary proximal hypospadias repair using grafts for urethroplasty. We
report results in consecutive patients with penoscrotal to perineal hypospadias and ventral curvature >30°, with
modification to improve outcomes.
MATERIAL AND METHODS
2-stage graft repair was used in all cases when curvature >30° after degloving resulted in urethral plate transection.
Persistent curvature >30° thereafter was straightened by 3 ventral corporotomies without corporal grafting.
Urethroplasty grafts were taken from inner prepuce or lower lip (when prepucioplasty was requested), with 2-layer
tubularization and tunica vaginalis coverage in all cases at the 2nd stage done 6 months later. Patients were divided into
2 consecutive groups : Group 1 - "standard" glans wings dissection opening laterally along the corpora to 3 and 9
o'clock by a surgeon and trainee; Group 2 - "extended" glans dissection to 3 and 9 o'clock, then freed another 4mm
cephalad from the corpora, by a co-surgeon team. Data was prospectively recorded in a database.
RESULTS
65 patients had 1st stage repair, of which 47 (72%) had ventral corporotomies. 49 (75%) had prepucial urethroplasty
grafts. Graft contracture occurred in 6%, with no difference between graft types or in those with vs without ventral
corporotomies. The 2nd stage was completed in 22 Group 1 and 28 Group 2 patients with average follow up of 7m and
6m, respectively. Urethroplasty complications (UC) occurred in 10 (45%) Group 1 versus 4 (14%) Group 2 patients,
p=0.02, comprising 12 glans dehiscences, 1 fistula and 1 recurrent curvature >30°.
CONCLUSIONS
3 ventral corporotomies without corporal grafts straightened curvature >30°with 2% recurrence. Graft take was
successful in 94%, with no difference when placed over corporotomies vs intact corpora. Glansplasty modification
increasing mobilization of the glans wings significantly reduced UC. Success can be achieved in 85% of patients with the
most severe hypospadias using 2-stage graft repair.