Abstract
Background
The optimal approach for repairing severe hypospadias remains debated. In our institution,
the single-stage double-face preputial island flap (DFPIF) has been employed to reduce
the number of procedures and costs. Given the resource-limited context, an evidence-based
comparison of repair techniques was warranted to inform cost-effective surgical decision-making.
Patients and Methods
A prospective randomized study was conducted on 36 patients with proximal hypospadias
and chordee >30 degrees, treated between 2022 and 2025. Patients were randomly allocated
to Group A (DFPIF) or Group B (Byars' flap) using a computer-generated block randomization
with allocation concealment. All surgeries were performed by the same team. Patients
were followed for 12 months. Groups were compared regarding complications, functional,
and cosmetic outcomes. Functional outcomes were assessed using parent-reported urinary
stream and erection, with objective chordee assessment under anesthesia. Cosmetic
results were evaluated using the Hypospadias Objective Scoring Evaluation (HOSE) score
and a 10-point parental satisfaction scale. Outcomes were assessed by a blinded team
member who was not involved in the operative procedures. Data were analyzed by a blinded
analyst.
Results
Thirty-six patients were included, with 18 patients in each group. There was no statistically
significant difference in complications, except for partial wound dehiscence, which
was higher in group A (p = 0.041). Functional and cosmetic outcomes, as well as parental satisfaction, did
not differ significantly.
Conclusion
While both techniques achieved acceptable early outcomes, the double-face flap group
showed higher rates of partial wound dehiscence. Further studies with larger samples
and longer follow-up are required to determine long-term efficacy and safety.
Keywords
hypospadias - severe chordee - double-face - single-stage - Byars' flaps
