[One-stage correction of scrotal and perineal hypospadias with buccal mucosa].

Delayed correction of genital malformations can have a negative influence on the emotional, psychosocial and cognitive development. Early one-stage-correction to give as near-normal an appearance and function as possible is therefore desirable. This can now be realized in most forms of hypospadias. However, in the rare and most severe forms (5-6%; scrotal and perineal forms) this is technically very demanding. It is extremely difficult for a surgeon to accumulate enough relevant experience, so that one-stage correction is performed only by very few. To investigate results with one-step correction, 100 of 163 cases treated up to 2006 were analyzed. Analysis of the first group of 50 consecutive cases operated on between 1996 and 2001 showed a complication/reoperation rate of 22% (11 cases). The 11 children required a total of 18 (36%) corrective surgical interventions. In 42 cases buccal mucosa was used as a tube onlay. In this group one- stage correction was successful in 39 (78%); 4 patients required two operations and 7 three. Children in group II were consecutive patients operated on between 2003 and 2006. In this group there was a reoperation rate of 12% (6 cases, in 1 of which severe lack of skin made one-stage correction technically impossible). In 45 cases buccal mucosa was used for a tube-onlay. Thus, in group II 44 patients (88%) underwent successful one-stage correction and 6 had two operations; none had three. The significantly lower complication rate in group II is presumably due to greater experience of the surgeons. All strictures observed developed at the level of the glans. In no case was buccal mucosa rejected; nor did any strictures develop between urethra and neo-urethra, being reliably prevented by the connection, with an onlay, to the recessed urethral plate. None of the 100 children became a 'hypospadias cripple'; in all cases satisfactory correction was ultimately achieved. This means that with growing experience one-stage correction can be increasingly reliably achieved. This is not a general call for one-stage correction, but an appeal for patients with these most severe forms of hypospadias to be treated only in specialized centers with the aim of allowing experience to accumulate there so that the results become more reliable.