# Outcomes of Two-Staged Repair Procedures for Adult Penoscrotal Hypospadias: A Retrospective Analysis

## TL;DR

This study compares two surgical approaches for fixing penoscrotal hypospadias in adults, finding that a two-stage method leads to better outcomes.

## Contribution

The study introduces a two-stage repair technique using buccal mucosal grafts and tunica vaginalis flaps for adult penoscrotal hypospadias.

## Key findings

- The two-stage repair had a 60% success rate compared to 30% in single-stage repair.
- Group 1 had fewer urethrocutaneous fistulas and infections compared to Group 2.
- Early removal of the Foley catheter was associated with improved outcomes in the two-stage procedure.

## Abstract

Objective: This study aimed to describe a two-stage repair technique (buccal mucosal grafting in Stage 1 and tunica vaginalis flap in Stage 2) and to evaluate its outcomes.

Methods: Ten cases of penoscrotal hypospadias with ventral chordee in adults were treated with two-stage repair (Group 1). Chordae correction was done in the first stage, a thin and unhealthy urethral plate was excised, and a buccal mucosal graft of 3-4 cm width was placed. The second stage was undertaken after three months, in which the neourethra was tabularized over a 14-Fr silicone catheter with the tunica vaginalis flap as the subsequent layer. Foley removal was done on postoperative day 5. The outcomes were compared with single-stage repair (Group 2) (n = 10) cases.

Results: While six cases had an excellent outcome in Group 1, only three had success in Group 2. Only one patient in Group 1 developed a urethrocutaneous fistula (UCF); Group 2 had five patients with UCF. In Group 1, one patient developed an infection with complete suture line disruption, and Group 2 had three cases each of wound infection and wound dehiscence. One patient in Group 1 and two in Group 2 developed superficial glans necrosis. The two-stage repair has a higher success rate than the single-stage repair (60% vs. 30%).

Conclusion: Staged repair and use of 14-Fr Foley and early Foley catheter removal improve adult penoscrotal hypospadias repair outcomes.