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    • Comparative Study Between Modified Koyanagi and Duckett Tube Techniques in Management of Proximal Types of Hypospadias

    Wael Ghanem MD*, and Mohamed Eldebeiky MD, FRCS*, Ayman Albaghdady MD*
    *Pediatric Surgery Department – Ain Shams University

    Objectives: To evaluate the surgical outcome of Modified Koyanagi and Transverse Preputial Island Flap (TPIF) repair for proximal penile hypospadias. Methods: The prospective study was conducted at the Pediatric Surgery Department, Ain Shams University Hospitals from October 2010 to September 2015. A total of 60 patients with proximal penile hypospadias in the age range of 8 months to 10 years were included. Patients with hypospadias other than proximal penile and those with a history of previous hypospadias repair were excluded. Patients were divided into two equal groups. Duckett tube (TPIF) urethroplasty was done for group A and modified Koyanagi repair for group B. The follow-up period was 12 months. SPSS 16 was used for statistical analysis. Results: Mean operative time was 86±9.62 minutes for TPIF urethroplasty, and 91±16.45 minutes for Modified Koyanagi repair (p<0.0001). In group A, 7 (23.3%) patients had complications, while in group B, 6 (20.0%) patients developed complications (p=0.02). Glanular disruption was observed in two patients (one in each group) (3.3%). Necrosis and sloughing of neourethra with subsequent disruption of the repair occurred in two patients (one in each group) (3.3%). Meatal stenosis occurred in 2 patients (one patient in each group) (3.3%). Urethral stricture was found in two patients (one patient in each group) (3.3%). Five patients developed urethracutaneous fistula, small temporary fistula in one patient (group A) (3.3%)was noticed on the 10th postoperative day, while in four patients (two in each group) (6.6%)there was more than one fistula was found. Conclusion: Duckett and modified Koyanagi repair techniques could be considered as acceptable and clinically equivalent as one stage procedure for primary proximal hypospadias with severe degree of chordee, small sized penis or with narrow urethral plate, provided that a good selection of cases for each type of repair was achieved. Key Words: Modified Koyanagi technique, Duckett Tube technique, management of proximal types of Hypospadias, clinically equivalent results, urethra-cutaneous fistula, urethroplasty. 

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