Choosing the method of correction of proximal hypospadias in children

Proximal hypospadias could be treated using both one and multiple steps procedure. One hundred and twenty five boys with proximal hypospadias (age from 6 months to 17 years) were operated in the period from 2008 to 2012. Mean age was 2.2 years. This group contained 41 patients with proximal trunk hypospadias, 35 - with penile-scrotal, 36 - with scrotal and 13 with perineal forms. Among the patients 94 were primary patients (75.2%) and 31 were operated earlier (24.8%). All patients were divided in two groups. The first group included 62 patients, which were operated in 20082010 years using one-stage urethroplasty with transversal tubularized flap of the foreskin (Duckett) in 43 cases and staged procedures: expansion of the penis and two-staged urethroplasty (Cecile I-II) in 19 patients. Second group included 63 patients, who were operated in period 2010-2012 years and in whom 2-staged operation (Bracka, Cukcow, 20 patients) or modification of one-staged urethroplasty using transversal foreskin flap (Duckett, 43 patients) were done. The essence of the modification is in the mobilization of penile glans wings with their superficial suturing, wide urethral anastomosis side-to-side, covering the neourethra with the flap of the dartos muscle and bladder drainage with cystostomy. Outcomes were systematized during the follow-up (from 6 months to 3 years). The most common complication was urethral fistula, however the re-operations were successful. Urethral stenosis was eliminated using urethrotomy and prolonged catheterization with urethral stents (1 month). Complications in the first group occurred in 25% cases after one-staged urethroplasty and in 15% cases after staged treatment. In the main group with Duckett urethroplasty modification we have observed complications in 15% of patients and in 5% of patients after two-staged operation according to Bracka.