Modified koyanagi repair for severe hypospadias

Abstract

Aim:To report the results of an early series of patients who underwent modified Koyanagi repair for severe hypospadias.Materials and Methods:A total of 24 boys (age: 9 months to 11 years) with proximal hypospadias, chordee, and poor urethral plate underwent modified Koyanagi repair between September 2008 and January 2012. Nine boys had associated penoscrotal transposition that was corrected simultaneously. Vascularized parameatal based foreskin flap was used to correct the hypospadias in a single stage. The follow-up ranged from 6 months to 3.5 years.Results:A total of 13 of the 24 children had a good outcome and were voiding normally, while 11 boys developed complications, 3 of which were major and 8 minor. The major complications were complete breakdown (n = 1), meatal and distal neourethral stenosis requiring laying open of distal urethra (n = 1), and glans breakdown (n = 1). The minor complications included fistulae (n = 5), meatal stenosis amenable to dilatation (n = 1), and lateral chordee (n = 1). Majority of the complications were in the initial patients, with successful outcomes in the last 1 year. Most of these complications were successfully managed by minor second procedures.Conclusion:Modified Koyanagi repair not only corrects severe hypospadias with chordee but also corrects the associated penoscrotal transposition in a single stage. The results are good once the learning curve is crossed.

Outcomes of Hypospadias Repair Based on Surgical Techniques: A 4-Year Retrospective Study

“… 18 Modified Koyanagi repair involves urethroplasty and results in the additional benefit of correcting any associated penoscrotal transposition with a vascularised parameatal-based foreskin flap, thereby allowing the use of the distal urethral plate as the base for the distal neourethra. 19 …”

“…18 Modified Koyanagi repair involves urethroplasty and results in the additional benefit of correcting any associated penoscrotal transposition with a vascularised parameatal-based foreskin flap, thereby allowing the use of the distal urethral plate as the base for the distal neourethra. 19 Snodgrass et al 20 encouraged to incorporate the urethral plate in the hypospadias repair as it showed healthy, wellvascularized connective tissue microscopically. However, his study included mainly patients with distal hypospadias.…”