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A 1.5 years old boy was referred to us from Goa with severe hypospadias and chordee, diagnosed as scrotal hypospadias with chordee. The urinary opening was near the end of the scrotum. The penis was also significantly bent (chordee). Since our center specializes in single-stage urethroplasty, we decided to do a single-stage repair, specifically Child Severe Hypospadias Koyanagi urethroplasty.

As a first step, the penis was degloved and the chordee was corrected using 12 O’clock tunica plication. The Koyanagi flaps were raised on either side, going on the top of the penis, and these were then joined together in the midline and finally tubularized using 6-0 PDS over 8 Fr stent.

Second layer coverage was done with Tunica Vaginalis flap and prepuce on top was split in midline and brought ventrally or coverage of skin. The child did very well and required no further surgery.

Master VM, a 1.5-year-old boy with severe hypospadias, was brought to the clinic from Surat. On examination, the urinary opening was scrotal in location. There was significant chordee also. The final diagnosis thus was Scrotal Hypospadias with chordee. Everywhere else, he had been advised a staged urethroplasty requiring three surgeries. A single-stage urethroplasty was planned for the child with severe hypospadias. As the first step, the penis was degloved to obviate the chordee. Even after degloving, significant chordee was still seen. A 12 O’clock tunica albuginea plication stitch was taken, and the penis was straightened. The chordee correction test showed no residual chordee.

A decision was made to make a tube from the dorsal prepuce and use it as a new urethra by rotating it towards the underside of the penis. This is called a single-stage “prepucial tube urethroplasty,” one of the complex repairs for severe hypospadias.

A prepucial flap was outlined and was harvested with good dartos blood supply. This was then brought ventrally and sutured to midline tunica albuginea with PDS to lay a base for tubularisation. Then this flap was tubularised over a 7Fr catheter as a new urethra Glans repair and a new urethral opening was made. The prepuce was split in midline and brought towards underside to cover the new urinary passage.

B.Q., a 7-month-old baby, was brought to our clinic with an abnormal-looking penis and passage of urine from the underside of the penis. On examination, he had a scrotal hypospadias with mild chordee (an abnormality where the penis is bent downwards).

A boy with scrotal hypospadias – Transverse Island Onlay Flap urethroplasty was planned for corrective surgery. This specific case involved a single-stage urethroplasty, for which many different techniques are available. The exact technique in this case was a long transverse island flap urethroplasty.

This is the appropriate age (6-9 months) for such surgeries as the final results are very good both cosmetically and functionally at such a young age. We chose to give two doses of hormones before surgery to improve the outcome after single-stage surgery.

Since this was a very severe hypospadias, the chances of failure were higher. We decided to harvest a tunica vaginalis flap for second-layer coverage of the repair (see pictures). The tunica vaginalis is a covering of the testis and provides good second-layer coverage in such severe cases, improving the outcomes manyfold.

The baby was taken up for surgery and required only a one-day stay in the hospital. The dressing was removed on day 5 and the catheter on day 12. There was no fistula or dehiscence.

At the 3-month follow-up, he had a normal-looking circumcised penis with a urethral opening at the top of the glans.