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Subject Area

Plastic Surgery

Article Type

Original Study

Abstract

Objective To evaluate the outcome of Koyanagi technique modification using dartos muscle as a second layer, because it has a high vascularity, very thin, easily elevated, and leaves no complications. Background One-stage urethroplasty through parameatal foreskin flap (OUPF) available for all types of hypospadias was first described by Tomohiko Koyanagi (1983), although high complication rates were reported. The aim of this study was to straighten the results of this method after adding dartos muscle flap between the constructed urethra and covering skin. Patients and methods This study was conducted in the Plastic Surgery Department at Menoufia University, during the period of April 2017–April 2019. Thirty cases for proximal hypospadias were included in this study. After chordee release, urethra was constructed using Kusanagi technique and adding scrotal dartos muscle flap as a second layer. Results Patient's age ranged from 1 to 4 years with mean age of 2.83 ± 1.17 years. All of the 30 cases with proximal hypospadias had severe chordee. Early complications were detected, such as bleeding in two (6.6%) patients. One (3.3%) patient reported for retention due to obstruction of the inserted catheter. Another case (3.3%) showed wound infection. The reported late complications were fistula in six (20%) patients, meatal recession in five (16.6%) patients, meatal stenosis in three (10%) patients, and diverticulum in one (3.3%) patient. Conclusion The modified Koyanagi one-stage repair of proximal hypospadias is an innovative technique and realizes many criteria for the expected effective operating results. The use of dartos muscle flap as a cover for the urethroplasty improves the results and minimizes complications.

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