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It is still debatable whether single- or two-stage urethroplasty is a more suitable technique for treating hypospadias with severe chordee after urethral plate transection. This retrospective study evaluated these two techniques. A total of 66 patients of proximal hypospadias with severe chordee were divided into two groups according to the techniques they underwent: 32 and 34 patients underwent single-stage (Duckett) or two-stage urethroplasty, respectively. Median ages at presentation were 7.5 years and 11.0 years in single-stage and two-stage repair groups, respectively. Median follow-ups were 28.5 months (20-60 months) and 35 months (18-60 months) in the single-stage and two-stage groups, respectively. The meatus of the neourethra was located at the top of the glans in all patients. No recurrence of chordee was found during follow-up, and all patients or parents were satisfied with the penile length and appearance. Complications were encountered in eight patients in both groups, with no statistically significant differences between the two techniques. The late complication rate of stricture was higher after the single-stage procedure (18.75% vs 0%). The complication rate after single-stage repairs was significantly lower in the prepubescent subgroup (10.52%) than in the postpubescent cohort (46.15%). These results indicate that the urethral plate transection effectively corrects severe chordee associated with proximal hypospadias during the intermediate follow-up period. Considering the higher rate of stricture after single-stage urethroplasty, two-stage urethroplasty is recommended for proximal hypospadias with severe chordee after urethral plate transection.

Objective: To investigate the outcome between the primary and secondary hypospadias with severe chordee in older patients by the transverse preputial island flap (TPIF)., Materials and Methods: We retrospectively analyzed 53 hypospadias patients who were performed with TPIF for urethroplasty, including 25 primary hypospadias (Group 1) and 28 secondary hypospadias (Group 2). The mean age in Group 1 was 12.12 ± 10.709 and 18.64 ± 8.727 in Group 2 (P = 0.0181). The mean follow-up time was 38.7 months (22-60 months)., Results: All of the foreskin flaps survived after the operation without necrosis. The overall complication rate was 24 % in Group 1 and 53.57 % in Group 2 (P = 0.0280). All the patients were also divided into two cohorts according to their ages in surgery. In the 0-10-yr cohort, there was a significant difference in the overall complication rate between the primary and secondary groups (P = 0.0173). But in the cases who were over 11 year old, there was no significant difference in the overall complications between two groups (P = 0.1603). Also no significant difference was found in the mean length of the urethral defect between two groups (P = 0.8312)., Conclusion: The Duckett technique is an optional choice for some older Chinese patients undergoing primary operations, but it has a higher complication rate in those who have undergone previous failed urethroplasties. The unsatisfactory results found in the reoperative group were supposed to be linked to the older age, the lack of subcutaneous flap coverage and local scar tissue, but not to the length of the urethral defect.

Objective: To present the experience in using the Snodgrass technique, Duckett repair and bladder mucosa grafting for hypospadias., Methods: We retrospectively reviewed 251 cases of middle and posterior hypospadias treated by the Snodgrass technique, Duckett repair and bladder mucosa grafting from February 1997 to December 2008., Results: The success rates of the Snodgrass technique, Duckett repair and bladder mucosa grafting were 80.3% (53/66) , 76% (19/25) and 78.9% (15/19) for middle hypospadias and 68. 3% (41/60) , 63.6% (14/22) and 88. 1% (52/59) for the posterior type without statistical significant differences (all P > 0.05). Bladder mucosa grafting showed a significantly higher success rate than the other two procedures in either one-stage or two-stage surgical repair of posterior hypospadias (P < 0.05). Duckett repair achieved a significantly higher rate of success in children under 14 years than in the older ones (P < 0.05)., Conclusion: Of the three surgical options, bladder mucosa grafting is the most suitable for posterior hypospadias, and Duckett repair is recommended for children under 14 years of age.

Objective: To study the clinical effect of Duckett's procedure of one-stage urethroplasty with the transverse preputial island flap in the treatment of hypospadias., Methods: We retrospectively studied 20 cases of hypospadias treated by Duckett's procedure of one-stage urethroplasty with the transverse preputial island flap (Group A) from 2003 to 2007. The patients ranged in age from 2 to 22 years (mean 11.3 years). Another 30 hypospadias patients aged 7 to 34 (mean 16.1) years underwent urethroplasty with mucous membrane of the bladder (Group B) in the same period. Of the 50 cases, 13 were the penile type, 33 the penoscrotal type, 2 the scrotal type, and 2 the perineal type. Catheters were indwelled in Group A, but both cystostomy and catheter indwelling were used in Group B., Results: For Duckett's procedure, surgery succeeded in 17 cases (85%), urethra stenosis developed in 1 (5%) and urinary fistula in 2 (10%), which were successfully repaired 6 months after the operation. The mean operation frequency was 1.1 per patient. In Group B, the operation was accomplished in 2 stages and succeeded in 26 cases (86.7%), with postoperative development of urinary fistula in 3 (10%) and urethra stenosis in 1 (3.3%). The mean operation frequency was 2.1 per patient. The 2 cases of postoperative urethra stenosis were both cured by urethral sounding., Conclusion: Duckett's procedure of one-stage urethroplasty with the transverse preputial island flap is effective in hypospadias repair, with a success rate close to that of other types of operations and a low rate of postoperative complications. Compared with the use of mucous membrane of the bladder, it has the advantages of one-move accomplishment and gives a better penile appearance.