Experience with 81, 1-stage hypospadias/chordee repairs with free graft urethroplasties.

We performed 81, 1-stage hypospadias/chordee repairs with preputial free graft urethroplasty between January 1981 and July 1988 using a modified Horton-Devine technique. Of the free grafts 37 were fashioned as patches, 42 as tubes, and 4 as a combination patch and tube. Of the patients 58 (72%) underwent single or multiple dorsal plications, in addition to the usual procedures, to correct chordee completely. A total of 35 patients (43%) required a second procedure: 28 (34%) for persistent fistula and 7 (9%) for stricture. These reoperations were typically minor outpatient procedures. All patients had an excellent functional and cosmetic outcome. Although the need for reoperation unfortunately is high, we believe the use of free grafts allows for a better functional and cosmetic outcome because the secondary torsion and bulkiness of the penile shaft caused by the vascular pedicle are eliminated. This is especially noticeable in patients with a small penis.