Two-Stage Urethroplasty for Severe Primary Hypospadias

Surgical repair of hypospadias is challenging and problematic even for the most experienced specialists, and this is especially true when severe and complicated case is confronted. In the history of hypospadiology, surgeons have developed a vast armamentarium of hypospadias repairs that are still in use, with no procedure able to deal with varied cases universally. Debates persist, though the focus of controversies alter. Sometimes we found us involved in a regeneration of old era, an example occasion is that many of us nowadays are faced upon the aroused enthusiasm of two-stage repair for severe hypospadias. In the early era of hypospadias surgery, two-stage correction with orthoplasty and urethra bed substitution only or as stage I repair, followed by urethroplasty in stage II is a widely accepted strategy in hypospadias repair. The representitive techniques include Denis-Brown procedure and its varied modifications. These techniques are still in use in many centers nowadays (Bar et al, 2005; Brown, 1949; Gearhart & Witherington, 1979; Patel & Caldamone, 2010). The reason of wide acceptance of such techniques is more for technical simplicity tnan for satisfactory function or cosmesis. In that days, single-stage accomplishment of hyopspadias repair for surgeons was a dream but nightmare concerning the technical poverty and disappointing outcome. It was largely the contribution of John Duckett that the concept and technique of single-stage repair gained worldwide acceptance. The classic transverse prepucial island tube technique became the norm in numerous centers and is still the mainstay for correction of severe hypospadias in many centers currently (Duckett, 2002a, 2002b; MacGillivray et al, 2002; Soutis et al, 2003). With attention paid to long term outcome and pursuit on cosmesis as time goes on, pitfalls of such island and tube flap urethroplasty in one stage have been seriously concerned by more and more authors. Meatal configuration, glans appearance, limited local tissue for repair, indeed high complication rate in long-term follow-up, the problems such as fistula, glans/neourethra dihiscence, stricture, urethral diverticulum, are all included in criticism and reevaluation. (Castanon et al, 2000; Dermibilek et al, 2001; Dewan et al, 1991; Lam et al, 2005; Powell et al, 2000). Nowadays, a technique preponderance is obvious in management of mild to moderate hypospadias, ie, application of Snodgrass technique. But for those extremely severe cases, the popular single-stage strategies are still highly problematic. Inspired by free graft techniques used in plastic surgery, some specilists are back to the almost aridit field of two-