Modification of two-stage technique of bracka with preservation and tubularization of the urethral plate for repair of proximal hypospadias

INTRODUCTION: Surgical treatment of proximal hypospadias is associated with a number of difficulties and unsuccessful repeated interventions. The changing approaches to the treatment of hypospadias with the revision of the attitude to urethral plate provide new opportunities in resolving this problem. AIM: to improve the results of surgical correction of hypospadias by creating "artificial" urethra that is very close to a native one in its functional qualities. MATERIAL AND METHODS: From 2011 to 2017 . two-stage urethroplasty using Bracka technique was used in 41 patients with a proximal hypospadias aged 1-16 years. From those, 32 patients were undergone to primary intervention (78%), and 9 boys previously had unsuccessful urethroplasty performed by different techniques (22%). Oral mucosa graft was used in 9 patients (22%), and in other 32 cases inner preputial skin was harvested (78%). The classical and modified Bracka technique were performed in 19 and 22 cases, respectively. The urethral plate was preserved in 22 cases and "artificial" urethra was created by its tubularization, which contributes to the reduction of the required length of the harvested prepucial graft. RESULTS: The complication rate in patients after classical Bracka technique was 31.6% (n=6) in comparison with 4.5% in group of the modified urethroplasty (n=1). Thus, the efficiency of modified technique was significantly better than that of the classical intervention (<0,05). CONCLUSION: The preservation and use of urethral plate for urethroplasty during the two-stage surgical correction of the proximal hypospadias allows to decrease the total length of "artificial" urethra and to improve the properties of the newly formed urethra.