Staged proximal hypospadias repair: Modified thiersch duplay with midline incision in urethral plate followed by Mathieu urethroplasty

Purpose: Functional results, complications, cosmesis, operating time, and hospital stay were analyzed after staged urethroplasty for proximal hypospadias. Methods: Seventeen consecutive boys, mean age 17.7 plusmn] 1.6 months underwent a staged urethroplasty in the past 5 years. Urethral plate was tubularized and proximal hypospadias converted to distal. Hooded dorsal prepuce was buttonholed and transposed ventrally to cover the neo-urethra. Subsequently, a parameatal based flip flap urethroplasty completed the urethral reconstruction at mean age of 26.7 plusmn] 4.1 months. Results: Mean follow-up time was 2.8 plusmn] 1.7 years. Eighty-eight percent of boys who are now toilet trained and standing to void have a good caliber straight single stream of urine in a forward direction. Urethrocutaneous fistula was seen in 1 child (6%), and a simple fistulectomy with double layered closure was successful at first attempt of fistula closure. Cosmetic appearance of a natural vertical slit glanular meatus situated at normal position on the glans was achieved in all patients. Total mean operating time was 193.5 plusmn] 42.9 minutes and total mean duration of hospital stay was 3.4 plusmn] 0.6 days. Conclusion: Staged urethroplasty for proximal hypospadias results in a normal penis with good function, minimal complications, and excellent cosmesis.