Ahmad Hussain Mishwani, Maqbool Ahmad, Muhammad Rehan Burney.
Hypospadias: one stage repair.
Pak Armed Forces Med J Jan ;53(2):148-52.

To evaluate the cosmetic and functional results of one stage repair of hypospadias, using parameatal based flip-flap urethroplasty. A prospective study from 1990 to 2002 at AFIU Rawalpindi, CMH Kohat, Jhelum, and Pano Aqil Cantt. And AK CMH Muzaffarabad. Fifty patients underwent one stage repair of hypospadias by parameatal based flip flap urethroplasty, using ventral penile and scrotal axial skin flap. The urethral meatus was subcoronal in 6 (12%), Distal penile in 32 (64%), proximal penile in 8 (16%) and penoscrotal in 4 (8%). Some modifications and combinations were used to ensure better vascularity of the flaps; natural verticals slit meatus and reduce complications. An 8 Fr polythene feeding tube used as stent with its tip inside the urinary bladder was removed on 7th or 8th postoperative day. The mean follow up period was 12 to 36 months. We achieved good cosmetic and functional results in 86% patients. Urethrocutaneous fistula occurred in 3(6%) patients, meatal stenosis in 2 (4%), residual chordee in 1(2%) and disruption of repair due to flap necrosis in 1 patient. Only four patients required redo surgery for fistula, residual chordee and failed repair due to flap necrosis. Meatal stenosis responded well to regular dilatation with the cone tip of an ophthalmic ointment tube, twice daily for 2-4 weeks. Postoperatively the penis was straight with natural vertical slit meatus and good stream of urine. One stage parameatal based flip flap urethroplasty, with some modifications, give very good functional and cosmetic results in primary as well as salvage repair of hypospadias.

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