Repair of hypospadias: A critical appraisal of some currently employed procedures

A retrospective analysis was made of 165 hypospadias patients treated consecutively in the Division of Pediatric Surgery, Chang Gung Memorial Hospital at Kaohsiung between January 1, 1986 and September 30, 1993. Thirty-three patients (20%) had anterior hypospadias, and the remainder had the posterior. The fistula rate and overall complication rate in the repair of anterior variants were 0% for those undertaking release of chordee (0/3), the MAGPI procedure (0/17) and the Devine and Horton flip-flap technique (0/3), but were 30% and 50% respectively for those undertaking the Mustarde procedure (3/10, 5/10). The fistula rate and the overall complication rate in single-stage repair of posterior hypospadias were 24% and 31% respectively for the Duckett transverse island flap repair (25/103, 32/103), 75% for the Hodgson I and III procedure (3/4) and 100% for the Koyanagi wing flap flipping urethroplasty (3/3). They were 18% and 36% respectively for two-stage repair (4/22, 8/22). The fistula rate and the overall complication rate were 23% (38/165) and 31% (51/165) respectively in the entire series. Both decreased significantly from 31% and 39% in Period I (January 1986-December 1989, N = 89) to 14% and to 22%, correspondingly, in Period II (January 1990-December 1993, N = 78). Changes occurred in treatment policy from Period I to Period II: some procedures associated with a high complication rate were abandoned and there was more liberal use of the Duckett procedure. Results showed that success rate in hypospadias repair depends on both the experience of the surgeon and the choice of an appropriate technique.