New Modification of Koyanagi Technique Using Dartos Muscle Flap in Management of Proximal Hypospadias

Background: One stage urethroplasty through parameatal foreskin flap (OUPF) available for all types of hypospadias was first described by Tomohiko Koyanagi (1983). High complication rates were reported.   Objective: To evaluate the outcome technique modification using dartos muscle as a 2nd layer because it has high vascularity, very thin, easily elevated, and leaves no complications. Patient methods: This study conducted in Plastic Surgery Department at Menoufia University, during period April 2017 to 2019. Thirty cases proximal included this study. After chordee release, urethra constructed adding scrotal layer. Results: Patient's age ranged from 1 4 years with mean 2.83 ± 1.17. All 30 had severe chordee. Early complications detected bleeding 2 patients (6.6%). patient (3.3%) reported retention due obstruction inserted catheter. Another case showed wound infection. The late fistula 6 (20%), meatal recession 5 (16.6%), stenosis 3 (10%), diverticulum one (3.3%). Conclusion: modified repair is an innovative realize many criteria expected effective operating results. use cover improves results minimize complications.