Byars Flaps for Staged Urethroplasty

Management of proximal hypospadias is a challenge for all surgeons. It presents unique challenges to distal variants and the surgical approach is modified accordingly. There are many different variations on the theme for managing these patients, although there has been a shift away from single-stage repair to multi-stage repair due to concerns for worse outcomes and a higher complication rate. For the 2-stage repair, the principles are the same – correction of the penile curvature at the first stage in addition to creating a supple skin bed on the ventral penile shaft suitable for urethroplasty at the second stage. We proceed with a single ventral corporotomy for ventral curvature and cover this with dorsal-based Byars flaps in order to achieve proper ventral penile shaft skin coverage. We prefer flaps over grafts due to the ample blood supply, which aids the healing process.