Abstract
INTRODUCTION: Hypospadias is a common congenital malformation, with proximal hypospadias occurring in 20% of cases and having a higher incidence of complications than distal hypospadias. Surgical reconstruction varies between single-stage and multi-stage procedures, with no consensus on the optimal approach. OBJECTIVES: This study aimed to compare the outcomes of single-stage and staged repairs for proximal hypospadias in a lower middle-income country, focusing on complications, operative time, patient satisfaction, and overall surgical success. MATERIALS AND METHODS: An ambispective observational study was conducted at King George's Medical University, Lucknow, from May 2014 to February 2020. Sixty patients with proximal penile hypospadias and chordee were selected (29 from previous medical records and 31 were enrolled prospectively) and divided into two groups of 30 each: single-stage reconstruction and staged repair. Data on demographics, follow-up duration, complications, reoperations, and satisfaction were collected. The Hypospadias Objective Scoring Evaluation (HOSE) system as well as cosmesis was used to assess outcomes at 6-week follow-up. RESULTS: The mean age was 3.8 years for single-stage and 4.5 years for staged repair, with no significant age difference (P = 0.725). The mean operating time was 90 min for single-stage and 210 min for staged repair. Complication rates, including meatal stenosis and urethral stricture, showed no significant differences. However, graft rejection occurred in four staged repair cases (P = 0.112). The staged repair group had higher reoperation rates (26.67% vs. 13.33%, P = 0.062) and longer hospital stays (26.47 vs. 13.87 days, P = 0.0001). Staged repair achieved better slit-like meatus shapes (83.3% vs. 60%, P = 0.021) and higher satisfaction with residual skin (P = 0.004). HOSE scores showed significant advantages for staged repair in the urinary stream (P = 0.048) and erection outcomes (P = 0.001). CONCLUSION: Staged repair showed better cosmetic outcomes and satisfaction in specific areas but required more operative time and hospital stay. Single-stage reconstruction was more cost-effective and had fewer reoperations. The choice of procedure should consider patient-specific factors and resource availability.