The modified Koyanagi technique versus two-staged urethroplasty using buccal mucosal graft in managing proximal hypospadias: a randomized clinical trial

Background
One of the most challenging cases in correction is proximal hypospadias. There are many techniques used, but no technique has shown success or acceptance universally. The purpose of our study is to compare the modified Koyanagi (MK) technique and two-staged urethroplasty by buccal mucosal graft techniques in managing proximal hypospadias types regarding rate of success, postoperative complications, and cosmesis.
Patients and methods
A total of 40 patients with proximal hypospadias types were enrolled, and these patients underwent surgical repair using MK technique or two-stage urethroplasty using buccal mucosal graft techniques. Patients were randomized into two equal groups (=20): group A underwent MK technique, and group B underwent two-staged urethroplasty using buccal mucosal graft techniques. The follow-up ranged from 6 to 18 months.
Results
The rate of success was 60% in group A compared with 75% in group B. Higher incidence of fistula was in group A (six cases) than group B (two cases), urethral stricture was the same (two cases in each group), meatal stenosis was less in group A (two cases) than group B (eight cases), and residual chordee was more in group A (two) than B (one), with no penile rotation in both groups.
Conclusions
The MK for repair of proximal hypospadias is a good technique and gives successful surgical results but requires meticulous technique and tedious preservation of blood supply. Two-staged urethroplasty is a technically straightforward and feasible technique, with less fistula rate, but requires more time, as a two-session operation, with good results in severe chordee and success rate.