Proximal Hypospadias Repair Straightening and Closure (STAC) vs Straightening and Graft (STAG), Initial Stage Outcome; A Comparative Study

Background: Proximal hypospadias with severe ventral curvature represent a challenge to surgeons, to correct different degrees of curvature whilst reconstructing the urethra with the best possible aesthetic outcome and least possible number of complications.Objective: To compare the outcome of straightening and grafting procedure in STAC vs STAG, in proximal hypospadias repair surgery in terms of recurrent curvature, graft take, and graft contracture.Methods: Twenty-two male patients with proximal hypospadias associated with ventral curvature, undergone staged repair with oral buccal mucosa as a graft, divided randomly into 2 groups; group A, (STAC) repair (9 patients), and group B, (STAG) repair (13 patients), from November 2019 to November 2021. Ventral penile straightening procedure had been performed in form of urethral plate transection and 3 ventral corporotomies. Graft inserted at 2nd stage in STAC group after healing of corporotomy incisions, while directly inserted over the incisions in STAG group at 1st stage. Patients were followed up for 6 months for assessment of graft take, graft contracture, and recurrent curvature, which evaluated at beginning of second stage by goniometer.Results: All patients in (STAC) repair group had straight penis with no recurrent curvature, no graft contracture was noted, whereas in (STAG) group, (2) patients had minor ventral curvature of 15° which is corrected at beginning of 2nd stage, and (1) patient had partial graft contracture which was managed by local betamethasone. The graft took successfully in all patients of both groups.Conclusions: STAC and STAG repair for proximal hypospadias achieved successful and adequate straightening of severe ventral curvature degrees, with a slight advantage for STAC repair in terms of graft contracture and recurrent curvature, as the graft inserted over a completely healed smooth corpora in comparison to STAG in which graft inserted over a raw open corporotomies. Keywords: Hypospadias, Curvature, Straightening, Graft.