One stage repair of severe hypospadias: Original versus modified koyanagi technique

ABSTRACT

Although the original Koyanagi technique seemed applicable for the repair of severe hypospadias at or proximal to the penoscrotal junction, its use has resulted in a high complication rate. The technique was modified to ensure better vascularity of the flaps. The purpose of this study is to report the results of original Koyanagi technique and its modifications in patients with severe hypospadias. The original Koyanagi parameatal prepuital flap technique was performed in 16 boys with severe hypospadias [group I]. In a subsequent 11 patients, the modified Koyanagi technique was used to preserve blood supply to the flaps [group II] The meatus was located at or proximal to the penoscrotal junction in all patients. Moderate to severe degrees of chordee was noted in all of them. The median age of patients was 13 and 20 months at time of repair for group I and II respectively. Each patient was evaluated as regard to site of the new meatus, straightness of the phallus, and stream of urine, development of fistula, urethral or meatal stenosis, any other complication, and the need for another operation. Follow up ranged from 36 to 84 months in group I, and 3 to 36 months in group II. A fistula developed in 8 of the 27 patients [29.6%] The frequency of fistula was more common in group I [6116] than in group II [2/11]. Urethral diverticulum occurred in one patient in group II, and meatal stenosis in 2 in group I. Significant infection resulted in a regressed meatal position in 2 [one in each group]. Good cosmetic results were achieved in all except the latter 2 cases. Secondary operations were needed in 8 patients [6 in group I and 2 in group 2] The indication for secondary surgery were closure of persisted urethrocutaneous fistula in 6 patients [5 in group 1 and 1 in group 2] and regressed meatus in 2 [one in each group]. A single staged repair can be safely and effectively performed even in patients with the most severe penoscrotal hypospadias. The modified Koyanagi technique has relatively lower complication rate than original Koyanagi repair. The complication rate is acceptable considering the severity of these cases