A Comparative Study on Cosmetic and Functional Outcome in Patients Undergoing Single and Staged Repair for Proximal Penile Hypospadias

A BSTRACT Background: Proximal Penile Hypospadias (PPH) pose significant functional and cosmetic challenges. While two-stage repair is the traditional approach, single-stage techniques are increasingly used with favorable outcomes. Objective cosmetic assessment remains difficult; thus, the modified Pediatric Penile Perception Score (PPPS), incorporating phallic length and a meatal–glans complex, offers a simplified yet structured evaluation method. This study compares the functional and cosmetic outcomes of single-stage versus staged urethroplasty. Materials and Methods: This randomized observational study included 46 patients aged 6 months to 12 years with PPH and chordee >15°, excluding those with syndromic features, penoscrotal transposition, penile skin disease, or prior circumcision. Patients were randomized into single-stage ( n = 24) and staged ( n = 22) urethroplasty groups. Functional (complication-based) and cosmetic (modified PPPS score-based) outcomes were evaluated at 3 months postoperatively. Cosmetic evaluation was done both by a surgeon and by a parent. Results: Both the groups were age-matched, though anatomical variation remained. Urethrocutaneous fistula was the most common complication, occurring at similar rates (58.3% single-stage vs. 54.5% staged; P = 0.796). Meatal stenosis/retraction was more frequent in the single-stage group (16.7%), but not statistically significant ( P = 0.110). Cosmetic scores for phallus and meatal–glans complex favored single-stage repair, while overall appearance slightly favored staged repair. Conclusion: Both approaches yielded comparable functional outcomes. Single-stage repair showed better results in specific cosmetic domains, while staged repair offered marginally higher overall satisfaction. Parents were more critical in evaluating overall appearance, while surgeons evaluated meatal–glans complex scores more effectively.