الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Proximal hypospadias, defined by a urethral meatus located at the
penoscrotal junction after penile degloving in the operating room, is the
most severe manifestation of the hypospadias spectrum. And one of the
most challenging conditions to correct Recent efforts suggest a
complication rate that is much higher than previously reported for
proximal compared to distal variants1–3. This high complication rate is
worrisome. Many of the complications are not noticed until adulthood.
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 In essence; the Koyanagi technique can simply
be described as a two steps hypospadias repair completed in one-stage.
This procedure 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 a reduced complication rate.
The meatal based yoke is outlined and the inner incision is made
first, this allows the urethral plate to be mobilized sufficiently to excise
all of the lateral and ventral tissues that contribute to the chordee. The
outer incision is made but only through the skin, preserving the
underlying vascular supply to the skin flaps.
The reported series treated with a modified technique at many
institutions showed a lower complication rate of 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 and not to rely
entirely on the microvasculature emanating from the region of the
urethral meatus and its surrounding corpus spongiosum.
Summary
121
Snodgrass’ modification of the Thiersch–Duplay technique, the
tubularized incised plate (TIP) urethroplasty, has gained widespread
acceptance all over the world and become currently one of the most
popular techniques for hypospadias repair. Since its initial description in
cases of distal hypospadias, TIP urethroplasty has now been applied with
notable success to both proximal and reoperative hypospadias.
The results indicate that there is a strong preference for utilizing
the TIP technique, particularly in cases of distal, midshaft and proximal
hypospadias. While this may have had the effect of diminishing the use of
flaps and grafts in hypospadias surgery, it has by no means eliminated
their use. The tabularized incised plate urethroplasty can be used for
different types of hypospadias either alone or combined with other
techniques when there is paucity of healthy skin flaps.
In our study we evaluate modified koyanagi technique and twostaged
urethroplasty technique in treatment of primary proximal
hypospadias.
The study included 40 male infant and child patients with 20 for
each procedure with age group ranging from 6 months to 2.5 years old.