Comparative Outcomes in Staged Reconstruction of Proximal Hypospadias

Abstract

Objective: To report the overall incidence and spectrum of complications in a pooled cohort of 87 patients undergoing staged repair for proximal hypospadias and to evaluate outcomes based on number of stages required and the impact of different graft sources, as procedural risk factors.

Study Design: Retrospective observational study
Place and Duration of Study: This study was conducted at the Department of Plastic Surgery, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Pakistan from January 2023 to December 2024.

Methods: This retrospective observational study analysed 87 male patients with proximal hypospadias who underwent staged repair (63 two-stage, 24 three-stage) at a tertiary plastic surgery unit over an eight-years period
(2017–2024). The primary outcome was the incidence and spectrum of all postoperative complications in the collective cohort.

Results: Overall, complications occurred in 21 patients (24%). The most common events were urethra-cutaneous fistula in 11 (12.6%) and residual curvature in 7 (8%) and meatal stenosis in 3 patients (3.4%). There was no
statistically significant difference of complications between two or three staged repairs, but when analysed with regard to the sources of grafts (preputial vs labial), a very significant difference was noted, favouring preputial graft a far better substitution of urethral plate.

Conclusion: Preputial skin graft should be the preferred choice for urethral substitution in proximal hypospadias cases, whenever possible, while labial mucosal graft should only be used when preputial graft is not available.