Purpose: The one-stage repair offers the benefit of utilizing skin that have not damaged, has an intact blood supply and requires fewer hospitalization days, but it also depends on the surgeon's "expertise" and the family's preferences. Two-stage surgery is frequently preferred in severe primary proximal hypospadias. This study aimed to compare surgical and functional outcomes of one-stage vs. two-stage hypospadias chordal repair.

Methods: We conducted a comparative, non-randomized, prospective study on 60 patients with hypospadias with any degree of marked chordae. Patients were allocated to receive either one-stage or two-stage repair using onlay grafts and flaps. All patients were followed for one year postoperatively. The repair was completed six months later using the standard Thiersch–Duplay technique in those with a two-stage repair.

Results: Thirty patients were managed in a two-stage procedure (28 with onlay preputial flap and two with buccal mucosal graft), while the remaining 30 patients were managed with a single-stage hypospadias repair with preputial skin flap (tabularized or onlay). The blood loss and operative time were significantly higher in the two-stage procedure group (p <0.05). The success rate of surgery in the one-stage group was 80%, while the two-stage group had a success rate of 83%, indicating a statistically insignificant difference between the two groups. The postoperative complication rate was 20% and 17% in the one-stage and two-stage groups, respectively.

Conclusion: The one-stage correction is an effective surgical procedure for treating this condition, with short operative time and less blood loss without the need for a second stage.