Mahmoud ElFiky

Aim of the Study :Hypospadias repair is one of the commonest operations done in pediatric surgery centers, with an incidence of 1 in 200 to 1 in 300. The proximal type accounts for 10-15% of cases. In this study we describe the results of the Koyanagi Nanamura procedure, which combines a meatal-based flap and a pellicle island flap in a single procedure. It allows for excision of ventral midline chordee without jeopardizing the flap. The technique was modified to improve the blood supply to the neourethral flaps The modified technique was found to achieve nearly normal phallic cosmetic appearance with a low complication rate.

Methods: This study was conducted at the general pediatric surgery unit on 20 cases with proximal hypospadias operated by modified Koyanagi technique.

Main Results: Twenty cases were operated; with mean age was 2.83 ± 1.17 years. Sixteen cases (80%) were penoscrotal, 4 cases (20%) were perinea'. Six cases (30%) had associated external genitalia anomaly. Twelve cases (60%) received topical androgen for a mean period of 179 ± 0.66 months. Mean operative time was 193.5 ± 4184 minutes. The follow up period ranged from 2 to 12 months, with mean of 8.15 ±3.53 months. The overall success was fulfilled in 11 cases (55%), as they needed no reoperation. Early complications were bleeding (5%), urine retention (5%), infection (5%) and stenosis (15%) which responded to urethral dilatation. Late complications included penoscrotal fistulae (20%), meatal recession (25%), urethral diverticulum (5%) and torsion of the glans (5%).

Conclusion: A single staged repair can be safely and effectively performed even in patients with the most severe proximal hypospadias. Modified Koyanagi repair performed for severe hypospadias with chordee gives a good cosmetic and functional result.