Commentary to "Original Koyanagi urethroplasty versus modified Hayashi technique: outcome in 57 patients".
The approach to the management of severe posterior hypospadias is quite controversial and open to different opinions. The first crucial issue is represented by the definition of ‘severe hypospadias’ and the subsequent decision on which technique to select (single vs staged approach). There is inevitably a variation in choice which is surgeon dependent and it is impossible to reach a common consensus for an isolated specific repair. Indeed, the vast majority of (but not all) primary cases can be successfully treated in a single stage, but the final decision may often be made only at surgery when the outcome and the possibility to preserve the urethral plate can be assessed only after a sequential and standardized approach. In a minority of cases, persistent severe penile curvature or poor quality of the urethral plate (hypoplasia) will require its transsection and/or substitution. Among single-stage repairs the use of para-meatally based and fully extended circumferential foreskin flaps has been widely accepted and several modifications described. The main drawback of this technique is the complete commitment required at the beginning of the procedure when you make your initial skin incisions, which might overestimate the real need for this type of repair. This interesting article presents a large series of 57 patients comparing the Koyanagi technique (Ref. 4 in article) to the Hayashi technique (Ref. 5 in article), and reflecting the wide experience of three senior surgeons from two leading French institutions (Lyon and Paris) with