Single-Stage Repair in Proximal Hypospadias

• When the artificial erection test shows the curvature resolves with skin release and clearing of the fibrous band.
• When the urethral plate is wide, flexible, and well vascularized.
• When the glans is large enough to be closed over the channel without tension.

• Long-segment TIP repair — the plate is deepened and tubularized; a double-layer protective covering is used.
• Onlay island flap — a flap prepared from the foreskin is laid over the plate. It holds up well over long channels.
• Koyanagi and similar techniques — the channel is built in a single operation using broad flaps prepared from the skin and foreskin.

In this group, the surgeon goes in prepared for both plans. If the plate turns out to be inadequate on the table, the approach switches to a staged repair — that doesn't mean the operation failed, it means the right decision was made on the table. Both scenarios should be covered in the consent form.

• Surgery takes 3-4 hours, with a 1-2 night hospital stay.
• Catheter for 10-14 days — noticeably longer than in distal repair.
• Swelling and bruising can take 4-6 weeks to fully resolve.
• At 3-6 months, the urinary stream, opening width, and curvature are reassessed.