Long-Term Functional and Cosmetic Outcomes of Hypospadias Repair Using Different Surgical Techniques - A Multicenter Prospective Cohort Study

Sep 30, 2026

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Hypospadias repair seeks functional and cosmetic restoration, but long-term results depend on the surgical technique chosen. A prospective, multicenter cohort study enrolled 180 boys aged 6 months to 7 years undergoing primary hypospadias repair, with follow-up for at least 2 years. Urinary stream, cosmetic appearance, and complications were assessed across TIP, Onlay flap, and Bracka repairs. TIP showed superior cosmetic outcomes (92% parental satisfaction). Onlay flap had a lower complication rate (6.7%) and Bracka showed acceptable results for proximal cases with higher complications (15%). Functional outcomes were comparable across groups.

LanguageEnglish

CategoryHealthcare

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Pages3

Reading Time8 min

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Abstract

Background

Materials and Methods

Results

Conclusion

Introduction

Overview of hypospadias and goals of repair

Overview of surgical techniques

Materials and Methods

Original Research Long‑Term Functional and Cosmetic Outcomes of Hypospadias Repair Using Different Surgical Techniques: A Multicenter Prospective Cohort Study Nishant G. Xess, Kavita Tirkey, Ankita, Shyam Sundar Sahu, Abhishek Kumar Singh, Abhishek Ranjan, Priya Shalini Lakra, Hirendra Birua Department of Pediatric Surgery, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India Submitted: 08‑Aug‑2025 Revised: 21‑Aug‑2025 Accepted: 25‑Aug‑2025 Published: 17‑Dec‑2025 Abstract Background: Hypospadias repair aims to achieve both functional and cosmetic restoration of the penis. Long‑term outcomes vary depending on the surgical technique employed. Materials and Methods: A prospective, multicenter cohort study was conducted involving 180 patients aged 6 months to 7 years undergoing primary hypospadias repair. Patients were followed up for a minimum of 2 years to assess urinary stream, cosmetic appearance, and complication rates. Results: Tubularized incised plate (TIP) repair showed superior cosmetic outcomes with a 92% parental satisfaction rate. Onlay flap had a lower complication rate (6.7%), while the Bracka repair was reserved for proximal hypospadias and had acceptable results but higher complication rates (15%) . Functional outcomes were comparable in all groups. Conclusion: Surgical technique selection should be tailored based on hypospadias severity. TIP repair offers excellent cosmetic results in distal cases, while Onlay flap and Bracka remain reliable for more complex cases. Keywords: Bracka repair, functional outcomes, hypospadias, onlay flap, tubularized incised plate Introduction Hypbyosptahdeiasabisnoarmcaolngenplaital anocementmalofy characterized the urethral meatus on the ventral surface of the penis, which may be associated with chordee and an abnormal prepuce. It occurs in approximately 1 in 200–300 live male births and represents one of the most common congenital urological anomalies. The primary goal of surgical correction is to restore urinary and sexual function, as well as achieve a satisfactory cosmetic appearance.[1] Over the decades, more than 300 techniques have been described for hypospadias repair, highlighting the complexity and variation in outcomes. Among the most commonly adopted procedures are the tubularized incised plate (TIP) repair, the Onlay Island Flap technique, and the Two‑Stage Bracka Repair. Each technique has its own indications based on the severity and location of | Access this article online | | | --- | --- | | Quick Response Code:
| Website: [https://journals.lww.com/jpbs](https://journals.lww.com/jpbs) | | | DOI: 10.4103/jpbs.jpbs_1419_25 | the urethral meatus, quality of the urethral plate, and presence of chordee.[2,3] The TIP repair, popularized by Snodgrass in the 1990s, is widely accepted for distal and mid‑shaft hypospadias due to its simplicity and reproducibility. It involves a midline incision of the urethral plate to facilitate tubularization, with or without preputial skin flap coverage. Cosmetic results are generally excellent, but complications like urethrocutaneous fistula, meatal stenosis, and glans dehiscence still occur.[4] The Onlay Island Flap technique is typically reserved for cases where the urethral plate is inadequate for tubularization. It uses a preputial skin flap that is | Address for correspondence: Dr. Ankita,
Green Veiw Heights, Diwakar Nagar, Bariatu, Ranchi - 834 009, Jharkhand, India.
E-mail: [ankitag.26.12@gmail.com](ankitag.26.12@gmail.com) | | --- | | This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License (CC BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
For reprints [contact:](contact: WKHLRPMedknow_reprints@wolterskluwer.com)[ WKHLRPMedknow_reprints@wol

FAQs

What follow-up duration and outcomes were evaluated in this study?

Patients were followed for a minimum of 2 years. Urinary stream, cosmetic appearance, and complication rates were assessed.

How did cosmetic outcomes compare between the three surgical techniques?

TIP repair produced superior cosmetic results, with 92% parental satisfaction. Onlay flap and Bracka had acceptable results, but TIP showed the best cosmetic outcome in the reported findings.

Which technique had the lowest complication rate and how were Bracka outcomes characterized?

Onlay flap had the lower complication rate at 6.7%. Bracka repair was used for proximal hypospadias, with acceptable results but a higher complication rate (15%).

Sep 30, 2026

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