Hypospadias repair: the two-stage alternative.

One-stage repairs for hypospadias are attractive in concept and are currently in vogue, but many surgeons remain unhappy with their inherent limitations and drawbacks. Two-stage repair, reconstructing the new urethra with a full-thickness skin graft, offers a realistic alternative and the method described here can be applied to almost any degree of deformity, be it a simple primary case or salvage of a multi-operated and skin-deficient hypospadias 'cripple'. From a personal series of over 600 cases the author concludes that a two-stage operation is an acceptable price to pay for a repair that offers unique versatility, excellent reliability and a sophistication of function and aesthetics that is hard to achieve with one-stage methods.