Single-stage repair of severe hypospadias using dermal graft orthoplasty and Koyanagi-Hayashi urethroplasty: a case report.

Severe proximal hypospadias with marked chordee remains a reconstructive challenge, and the optimal choice between single-stage and staged repair is debated. We report a 41-month-old boy with mid-scrotal hypospadias, over 60 degrees of chordee, and penoscrotal transposition treated in a single stage by ventral dermal graft orthoplasty, Koyanagi-Hayashi urethroplasty, and tunica vaginalis flap interposition. At 26 months he had a straight penis, a glanular meatus, a normal urinary stream, and no fistula or stricture. Three independent vascular territories may mitigate the traditional graft-on-graft concern.