Abstract: Objective  To summarize the effect and complications of Duckett′s procedure to repair and reconstruct the urethra in the treatment of severe hypospadias.
Methods  A retrospective analysis was performed on the clinical data of 997 patients with severe hypospadias who underwent Duckett′s procedure to repair and reconstruct the urethra.
Results  A total of 997 cases underwent Duckett′s procedure of one-stage urethroplasty to reconstruct the urethra, and 708 patients were cured(the cure rate was 71.01%). There were 241 cases suffering urethral stricture, with an incidence of 24.17%, of whom 229 cases whose urethral stricture was mild were able to maintain unobstructed urine flow after intermittent urethral dilatation under local anesthesia.Nine patients experienced unsuccessful urethral dilatation, and then under general anesthesia, the urethra was expanded retrogradely through the internal orifice of the urethra, and the catheter was retained. After removing the urinary tube, intermittent urethra dilatation was performed to successfully solve the dysuria. There were 3 cases of urethral atresia after urinary tract infection and necrosis. The narrow segment of the urethra was opened under general anesthesia. Six months later, the urethra was reconstructed by snodgrass longitudinal rolling tube operation to allow smooth urination. Forty-five cases of urethral fistula occurred, with an incidence of 4.51%. For children with a small fistula,the urethra was retained again to drain urine, epidermal growth factor was applied to the fistula, and 5 cases were cured. Another 38 children with fistula could not heal themselves, and six months later, it was successfully resolved by urethral fistula repair. Two cases of urethral fistula reoccurred, and the urethral fistula was successfully resolved again by urethral fistula repair. There were 3 cases of urethral diverticulum, with an incidence of 0.30%; 2 cases had large diverticulum, which affected urination, and the urethra was cured by re-forming the diverticulum; 1 case who had small diverticulum was not treated temporarily, and regular follow-up was performed. All children were followed up for 6 to 36 months, and the end point of observation was unbostructed urination and absence of urethral dilation for 3 months.
Conclusion  Duckett′s procedure of one-stage urethro plasty for repair and reconstruction of the urethra is effective in the treatment of patients with severe hypospadias, and the clinical complications can be corrected by corresponding methods. Therefore, it is worthy of clinical promotion.

Key words: hypospadias, Duckett′s procedure, treatment outcome