Two-stage BILAB Technique for Correction of Primary Proximal Hypospadias with Severe Chordee

Abstract

Introduction: In recent years, the trend has shifted towards two-stage surgery to treat proximal forms of hypospadias with severe penile curvature. This evolution is explained by the high rate of complications associated with single-stage surgery, as well as the increasing need to address curvature, which sometimes takes precedence over urethroplasty itself in terms of priority. In 2013, A. HADIDI published his Bilateral Based Skin Flap Technique (BILAB) for the repair of perineal hypospadias associated with severe penile curvature. The aim of our study is to evaluate this technique, to specify its indications, and to analyze its therapeutic results. Materials and Methods: Prospective study of a heterogeneous series of 40 children presenting with proximal hypospadias, all operated on by the same surgeon using the two-stage BILAB technique. The average age of the patients at the time of surgery was 38.40 months. During this study, three corporotomies without grafting were performed in 15 children to complete the treatment of penile curvature. In addition, an intermediate flap taken from the tunica vaginalis was used to cover the urethroplasty in 37 patients. The functional results were carefully evaluated using a questionnaire designed to assess the satisfaction of parents as well as that of the surgeon, both functionally and aesthetically. Results: Complete straightening of the penis was achieved in all patients. We noted 4 cases of urethral fistulas, 2 cases of total urethroplasty breakdown, 1 case of partial breakdown, 3 cases of glanuloplasty breakdown, 3 meatal stenoses, and one distal diverticulum. The cosmetic appearance was very satisfactory for parents in 90% of cases. Conclusion: The BILAB technique, a modification of the original Koyanagi technique, is a good alternative for the management of severe forms of hypospadias. Correction of penile curvature sometimes requires additional procedures such as triple corporotomy to achieve complete straightening of the penis, and the aesthetic result is generally satisfactory. The complication rate is very low compared to other techniques, but parents should be informed of the risk of reoperations.