An investigation into the role of waterproofing in a two-stage hypospadias repair

In our unit a two-stage procedure, using a full thickness preputial graft, has been adopted as the method of choice for the repair of hypospadias proximal to the coronal sulcus. In 1993 an audit was undertaken to establish our complication rate for this procedure. Twenty-two consecutive patients who completed a two-stage repair between January 1988 and December 1993 were studied. An unacceptably high fistula rate was identified (63%, 14/22 cases). Consequently our technique was modified by transposing a vascularised flap of preputial areolar tissue over the urethral suture line, at the time of urethroplasty. A second group of 22 consecutive patients, operated upon between January 1994 and July 1997, were subsequently investigated and a dramatic improvement in the fistula rate was demonstrated (4.5%, 1/22 cases). These cases represent a subgroup of almost 200 cases, which the senior author has managed over the last 10 years. The senior author undertook or supervised the surgery in all 44 cases, which were the focus of this study, and the introduction of a waterproofing layer represents the only change in technique.