Koyanagi Procedure

Perineal hypospadias represents the most severe form of proximal hypospadias, posing significant challenges in surgical repair due to its complex anatomical features. Various surgical approaches have been devised with the aim of restoring normal penile function and achieving satisfactory cosmesis. These techniques primarily focus on either preserving the urethral plate or transecting it. Despite numerous attempts, existing surgical methods have demonstrated a notable incidence of complications and the need for redo surgeries. Koyanagi’s pioneering one-stage urethroplasty with parameatal foreskin flap, initially introduced in 1983, showed promising initial outcomes but encountered higher-than-expected complication rates upon further evaluation. Nonetheless, the Koyanagi technique remains a viable option for addressing severe hypospadias in experienced hands. This abstract outlines our center’s approach to the Koyanagi technique, detailing procedural steps, invaluable insights, and our center’s outcomes, contributing to the ongoing discourse on hypospadias repair strategies.