Outcome of Two-Stage (Bracka) Repair in Adult Hypospadias: Our Experience of Sixty Cases

Abstract

Objective: To assess the outcome of two-stage (Bracka) repair in adult hypospadias

Study Design: Prospective observational study

Place and Duration of Study: This study was conducted at the Department of Plastic Surgery Lady Reading Hospital Peshawar from January 2021 to March 2023.

Materials and Methods: A total of 60 patients who met the inclusion criteria underwent two-stage (Bracka) repair. In stage 1, chordee correction and a full-thickness skin graft taken from the retro-auricular area was placed. The patient was then followed regularly at 1-week, 1-month, and 3 months intervals. After 6 months, the second stage was performed where tubularization over a silicone catheter was performed. After the removal of the urethral catheter on the 7th post-op day, the patient was then followed at the 1st, 3rd, 6th month, and at one year.

Results: This study includes 60 patients with a mean age of 22.43+2.807 years. By location 43(71.7%) patients had distal penile while 17 (28.3%) patients had mid penile Hypospadias. A mild degree of chordee was recorded in 48(80%) cases. All 60(100%) patients were circumcised without other genitourinary abnormalities. The donor site for all patients was retro auricular.. After two-stage urethroplasty 48 (80%) patients had no complications, while the remaining reported to have fistula formation 5(8.3%), meatal stenosis 4 (6.7%),2 (3.3%) had a urethral stricture and 1 patient (1.7%) had repair dehiscence. Complications reported were managed in our Department. The different types of surgeries performed to overcome these complications were Meatotomy in 4(6.7%), Fistula closure in 2 patients (3.3%) and 3 fistulae closed spontaneously by applying manual occlusion. Redo 2 staged repair done in 2(3.3%) patients of urethral stricture. and Redo second stage in 1(1.7%) patient of dehiscence due to infection. The chi-square test was used to find the correlation between the degree of chordee and complications which was not statistically significant (p-value=0.36).

Conclusion: Two-stage (Bracka) Hypospadias repair in adult life has a comparatively high success rate with excellent cosmetic and functional outcomes as compared to single-stage repair.