Surgical results of complete hypospadias repair in two stages.

Between 1980 and 1992, 403 patients with hypospadias and with no previous operations were treated in Hyogo College of Medicine. Surgery was not performed in children younger than 3 years. The major points in the surgical repair were complete resection of the chordee, normal location of the meatus and reducing complications such as fistula formation or stricture. In order to achieve these aims we performed a two-stage repair, with the second operation at leat 12 months after the first one. In 57 of 245 patients with "chordee without hypospadias" and slight to moderate degree of hypospadias we performed surgery by the Crawford-Ikoma technique, which is characterized by 3 layers of watertight continuous sutures at the time of urethroplasty. The incidence of postoperative fistulae was 1.8%, the rate of strictures was 3.5%. After the Mays-Ikoma technique, where we perform a glandular urethroplasty in addition to chordectomy in the first stage, we diagnosed an urethral fistula in 7.9% and a stricture in 2.3%. A severe degree of hypospadias was seen in 158 patients. After performing the Crawford-Ikoma technique we acknowledged a rate of postoperative fistulae in 3.6% and strictures in 10.7%. The incidence of fistulae after the Mays-Ikoma technique was 8.9% and of strictures 1.1%. Altogether we found persistent chordee in 2 cases.