Clinical Outcome of Modified Thiersch Duplay Urethroplasty for Proximal Hypospadias

Abstract

Objectives: To report the functional results, complications and cosmesis by using Thiersch Duplay urethroplasty repair for hypospadias.

Patient and Methods: Between years 2006 to 2007, 30 patients underwent repair of proximal hypospadias (penoscrotal) with chordee. Two stage repair was performed in all cases. 1^st stage consisted of chordee correction by excising fibrous cord between ectopic meatus and corona along with incision of glans. The grafting of the dorsal hood skin was made on ventral aspect of tunica albuginea. In second stage repair U shaped incision was made around hypospadiac meatus and a ventral skin flap was dissected superficially to allow tubularization around a suitable size silicon Foley catheter (5 -8 Fr in children, 10-12 Fr adolescence and 14-16 Fr in adults) without tension. The Thiersch Duplay tube was constructed using 5/0 vicryl. A subcutaneous fascial layer was closed over tube to support neourthra. The Foley catheter was left for 10-12 days. Results: Age range was 3-25 years with mean ± SD of 12.7 ± 5.09.  Total hospital stay was 10-12 days with mean ± SD of 11.9 ± SD 0.85.  Twenty five patients (80.2%) could void on standing and had a good caliber straight single stream of urine in forward direction. The cosmetic appearance of a natural vertical slit glanular meatus situated at the normal position on the glans achieved in twenty five patients. Period of follow up was 4-8 month mean with mean ± SD of 6 ± 1.43. Main complications seen were urethrocutaneous fistulae in three (9.9 %), meatal stenosis in three (9.9%), hematoma in one (3.3%), complete disruption in one (3.3%) infection in two (6.6%) and painful bladder spasm in two (6.6%). These seen in five (16.5%) patients. Conclusion: Staged urethroplasty for proximal hypospadias results in a normal penis with good functional, minimum complications and excellent cosmesis, with short hospital stay.