الفهرس 
Preoperative managementOnly 14 pages are availabe for public view
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Abstract
A controversy exists regarding the optimum technique for repair of severe hypospadias. The multiplicity of procedures that have been described over the years is indicative of the fact that no procedure has been universally acceptable or successful. Many have chosen to perform staged procedures since this has the advantage that the varied anatomical issues can be fixed sequentially with different aspects of the problem being tackled in time. A disadvantage of this approach is that by necessity patients undergo at least two and often more procedures.. For many years there was a consensus that severe cases of hypospadias are better treated with a planned 2 stage approach rather than a single stage procedure. There has been a growing interest in one- stage repair of all varieties of hypospadias including severe types . A prerequisite for a one-stage repair is the presence of appropriate dorsal hood foreskin for a preputial based island flap and the adequacy of penile length for a one stage repair . Many authors believe that a planned one stage repair can offer comparable results and may spare the patients further surgical interventions. Even if there is a higher chance of secondary procedures, approximately two thirds of the cases of hypospadias will be corrected with one intervention. Furthermore, a well-performed single-stage repair does not compromise availability of vascular tissue for subsequent procedures . In 1984, Koyanagi et al., reported meatal based foreskin flap repair for proximal hypospadias. He used the inner layer of the preputial skin for urethral tubularization; this technique can simply be described as a two-step hypospadias repair completed in one stage . It combines a meatal based flap and a pedicle island flap into single procedure. It allows for excision of ventral midline chordee without jeopardizing the flap. It had a relatively high-complication rate, in part, because no major attempt was made to preserve the blood supply of the skin flaps. A modification of the technique was described, in which the vascularity of the flaps, resulted in reduction of complication rate. The higher success rate of the modified Koyanagi technique is believed to reflect the impact of preservation of the lateral blood supply to the skin flaps.