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Prof. Dr. Ali Avanoğlu
Hypospadias Surgery • Surgery in Children

Two-Stage Hypospadias Surgery

Staged repair is not a second surgery performed because of a complication — it is two steps planned from the very start. The first session prepares the foundation, the tissue matures during the interval, and the channel is built in the second session.

Who this is forCases where a staged repair is planned
Reading≈2 min
ByProf. Dr. Ali AvanoğluUpdated
This page is part of hypospadias surgery.Read the full treatment overview on the hub page
STAGE 1Curvature is corrected,graft is placed≈6 MOGraft maturesSTAGE 2Channel is formed
two-stage repair
01 · Stage 1: preparing the foundation02 · The interval03 · Stage 2: building the channel04 · Why is this path chosen?
In brief4 madde
  • Stage 1: preparing the foundation: The skin is released, the fibrous band is cleared, and the penis is made completely straight.
  • The interval: About 6 months.
  • Stage 2: building the channel: The graft is shaped into a tube.
  • Why is this path chosen?: A basic principle in surgery is that tissue under tension does not heal.
The pathtwo sessions, with a wait in between
  1. 1Stage 1 — the foundationthe skin is released, the band is cleared, the penis is straightened; tissue from the foreskin or oral mucosa is laid on the underside; a pressure dressing for 5–7 days
  2. 2The interval — ≈6 monthsthe graft softens and develops its blood supply; the child continues normal life, and urine temporarily exits through the opening on the shaft
  3. 3Stage 2 — the channelthe graft is made into a tube, the opening is formed at the tip, the head and skin are closed; a catheter for 10–14 days
01

Stage 1: preparing the foundation

  • The skin is released, the fibrous band is cleared, and the penis is made completely straight. The second stage does not proceed until straightness is achieved.
  • Tissue taken from the foreskin or the inner cheek (oral mucosa) is laid on the underside as the foundation on which the new channel will be built.
  • The glans (head of the penis) is prepared to receive this tissue.
  • A pressure dressing is applied over the graft and left undisturbed for 5–7 days — this is the most critical period for the graft to take.
02

The interval

About 6 months. This time is needed for the graft to soften, complete its blood supply, and reach the flexibility needed to be shaped into a tube; shortening it lowers the success rate.

  • The child continues normal life during this period: bathing, going to nursery, playing. Urine exits through the wide opening on the shaft; using nappies or sitting to urinate during this period is temporary.
03

Stage 2: building the channel

  • The graft is shaped into a tube.
  • The opening is created at the tip.
  • The glans and skin are closed.
  • The catheter stays in place for 10–14 days.
04

Why is this path chosen?

A basic principle in surgery is that tissue under tension does not heal. Tissue has to be added to the gap created while correcting the curvature, and added tissue cannot immediately be shaped into a tube. Staged repair is a deliberate choice made not to increase the number of surgeries, but to reduce the total number of surgeries needed.

Related videos
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Frequently asked questions
How will the child urinate between the two stages?
Urine exits through the wide opening on the shaft. Younger children continue using nappies; older children sit to urinate. This period is temporary and does not seriously restrict daily life.
Can the waiting period be shortened?
No. Six months is the biological time the graft needs to mature. Early intervention leads to an inadequate graft and a failed repair.
Will a third surgery be needed?
In some cases, a third session may be needed for interim corrections. Knowing this possibility in advance means you won't be caught off guard if it happens.
Prof. Dr. Ali Avanoğlu's publications on this topic · 1
  1. Tiryaki S, Ələkbərova V, Dokumcu Z, et al. (2016). Unexpected outcome of a modification of Bracka repair for proximal hypospadias: High incidence of diverticula with flaps. Journal of pediatric urology. PubMed ↗
←Previous • Surgery in ChildrenDistal Hypospadias SurgeryNext • Surgery in ChildrenComplex Hypospadias Repair→
Related pagesFull index →
Surgery in ChildrenWhy Are Two Surgeries Needed?This is the question families struggle with most. The answer rests on a simple surgical fact, and understanding it makes the process much easier to go through.Surgical TechniquesOral Mucosa GraftThe thin layer of mucosa taken from inside the cheek is the most valuable backup tissue in hypospadias surgery. Because it tolerates a moist environment, and because it is thin and well supplied with blood, it is safely used as the lining for the new urinary channel.Surgery in ChildrenWhat Is Proximal Hypospadias?The urinary opening is at the base of the penis, at the penoscrotal junction, on the scrotum, or further back still. This group makes up roughly a fifth of all cases and is surgically the most demanding — but with a properly planned repair, good outcomes are achieved.After SurgeryAfter-Surgery Care GuideMost of the healing takes place in the first two weeks. What needs to be done during this period is simple; the most important thing is keeping the dressing and catheter exactly as your doctor described.
Hypospadias Surgery topic clustersMain treatment page →
Basics 8Surgery in Children 8Surgical Techniques 5After Surgery 9Recurrent Cases 4Hypospadias in Adults 8Follow-up and Assessment 5
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