Repair of Penoscrotal and Complicated Hypospadias by a Two-Stage Technique

The management of a sub-group of patients with penoscrotal hypospadias with severe chordee and those complicated cases due to failed previous attempts at repair is challenging and controversial. In this retrospective review, the management of 14 patients who had penoscrotal hypospadias or crippled hypospadias treated with a two-stage technique are discussed. The mean follow-up was 37.1 months (range 4-72). Mean age 8.1 years (range 15 months – 21 years). Nine patients (64.3%) had primary repair, while five patients (35.7%) had salvage repair. One patient had poor graft take. Five patients (35.7%) had urethro-cutaneous fistulae. Meatal stenosis in two patients (14.2%). Persistent chordee in one patient (7.1%). Urethral diverticulum, meatal retraction and urinary tract infection in one case each. Final cosmetic results as judged by near normal, slit- like meatus, and straight penile shaft, were achieved in all of the patients, except the one with meatal retraction. At the time of follow-up, all of the patients or their parents were satisfied with the cosmetic appearance. In conclusion, the two-stage repair may be a good alternative in the management of the most severe forms, and complicated cases of hypospadias.