Two-Stage Urethroplasty

Abstract

The first recorded case of staged hypospadias repair was that by Nové-Josserand in 1897. However, Humby (1941) must be credited for his reference to the use of skin grafts and that of buccal mucosa in the reconstruction of the urethra. Cloutier (1962) described a modified Denis-Browne repair where the glans was split and lined with full-thickness Wolfe graft of preputial skin at the first stage, thereby allowing the neourethra to be advanced to the tip of the glans at the second stage. Various authors have introduced technical modifications of the use of full-thickness Wolfe skin graft since 1955 (Byars 1955; Nicolle 1976; Rabinovitch 1988; Turner-Warwick 1979; Webster et al. 1984; Zhong-Chu et al. 1981). It was Turner-Warwick in 1979 who used the two-stage urethroplasty for adult salvage surgery and produced impressive results. Subsequently, Rabinovitch and Bracka have resurrected the two-stage hypospadias repair and have popularised this technique not only for retrieving failed hypospadias repairs but also as an alternative technique for primary hypospadias (Bracka 1995a, b; Rabinovitch 1988).