Modified Koyanagi Technique versus Two Stage Repair for Severe Forms of Hypospadias in Children

Abstract

The ideal surgical management of primary severe hypospadias remains controversial. Major trends in management have significantly changed during the last few decades. For a long time the two stage repair was considered the standard management. This concept has recently been challenged, with a renewed interest in techniques including transection of the urethral plate and its substituting urethroplasty such as Koyanagi procedure. Koyanagi’s modifications aiming at double blood supply improved its outcome and surgeons started to trust it more. Modifications were due to incisions that cut the skin and leave the underlying tissue and minimal dissection throughout the whole operation especially in lateral limbs of the V incision. It is becoming more popular since then. Several studies including our study are reporting more success rate and less complication rate than the original koyanagi. Our study is a prospective non randomized comparative study comparing the outcome of severe hypospadias using the modified koyanagi and the 2 stage repair. During the period from December 2014 till December 2016, 30 patients of severe hypospadias were presented to our department. 4 patients were excluded intra-operatively from the two main groups due to the feasibility of one stage Snodgrass repair. 6 patients in group II didn’t complete the stages of repair and so weren’t included in the statistical analysis. The remaining 20 patients were distributed as follows : 11 patients in group I and 9 patients in group I. Primary outcome: was the functional and cosmetic results that are assessed by both the HOPE and part of the HOSE scoring which are the stream and the presence of the fistula 6 months after the operation. Secondary outcom