{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T17:57:35Z","timestamp":1770141455821,"version":"3.49.0"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,8,25]],"date-time":"2022-08-25T00:00:00Z","timestamp":1661385600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82060129"],"award-info":[{"award-number":["82060129"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011827","name":"\u201cMedical Excellence Award\u201d funded by the Creative Research Development Grant from the First Affiliated Hospital of Guangxi Medical University","doi-asserted-by":"publisher","award":["2017026"],"award-info":[{"award-number":["2017026"]}],"id":[{"id":"10.13039\/501100011827","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Proximal hypospadias with severe chordee is still a formidable challenge for most pediatric urologists, and the treatment approach remains controversial. Here, we describe a modified two-stage technique to repair proximal hypospadias with severe chordee.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively identified 53 children referred for proximal hypospadias with severe chordee from July 2016 to July 2019, who underwent a two-stage urethroplasty. In group 1, the children were repaired with staged tubularized incised plate (TIP) urethroplasty, while Byars\u2019 two-stage urethroplasty was attempted in group 2. We corrected chordee by releasing all remaining attachments to the corpora after degloving the penis, transceting the urethral plate, and dorsal plication. The mean age of patients in the first stage of surgery was 26.6 months in group 1 and 24.8 months in group 2. Postoperative complications in the two groups included: fistula, urethral stricture, urethral diverticulum, and glanular dehiscence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 20 cases were repaired with staged TIP urethroplasty (group 1), and 33 cases were repaired with Byars\u2019 two-stage urethroplasty (group 2). The length of follow-up in group 1 was 39.8\u2009\u00b1\u200910.1 months, and in group 2, it was 38.1\u2009\u00b1\u20098.7 months (<jats:italic>P<\/jats:italic>\u2009&amp;gt;\u20090.05). After the second stage of surgery, 1 case (5%) in group 1 and 11 cases (33.3%) in group 2 developed a urinary fistula (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.05). One case (5%) in group 1 and three cases (9.1%) in group 2 had urethral stricture (<jats:italic>P<\/jats:italic>\u2009&amp;gt;\u20090.05). All strictures were cured by repeated dilation, and no patient required reoperation. No cases in group 1 and one case (3%) in group 2 had urethral diverticulum (<jats:italic>P<\/jats:italic>\u2009&amp;gt;\u20090.05). There was no residual chordee in both groups. Two cases (10%) in group 1 and 13 cases (39.3%) in group 2 required reoperation (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Staged urethroplasty is appropriate to repair proximal hypospadias with severe chordee. Particularly, staged TIP urethroplasty is a good choice for patients with proximal hypospadias and severe chordee, especially those with better penile development, wider urethral plate, larger glans, and deeper navicular fossa of the urethra.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2022.892048","type":"journal-article","created":{"date-parts":[[2022,8,25]],"date-time":"2022-08-25T06:23:14Z","timestamp":1661408594000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["The effect of staged TIP urethroplasty on proximal hypospadias with severe chordee"],"prefix":"10.3389","volume":"9","author":[{"given":"Qike","family":"Xie","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuling","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiangyou","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junqiang","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chao","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,8,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"951","DOI":"10.1016\/S0022-5347(05)67861-5","article-title":"Hypospadias and urethral development","volume":"163","author":"Baskin","year":"2000","journal-title":"J Urol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"965","DOI":"10.1007\/s00383-020-04697-x","article-title":"Bracka verses Byar\u2019s two-stage repair in proximal hypospadias associated with severe chordee: a randomized comparative study","volume":"36","author":"Wani","year":"2020","journal-title":"Pediatr Surg Int"},{"key":"B3","doi-asserted-by":"publisher","first-page":"196.e1","DOI":"10.1016\/j.jpurol.2016.05.002","article-title":"Hypospadias: are we as good as we think when we correct proximal hypospadias?","volume":"12","author":"Long","year":"2016","journal-title":"J Pediatr Urol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"28.e1","DOI":"10.1016\/j.jpurol.2015.06.011","article-title":"Proximal hypospadias: a persistent challenge. 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