Lateral Based Onlay for Recurrent hypospadias surgery (LABOR); A multicentre study.

OBJECTIVE: To report long-term outcomes of the Lateral Based Onlay Flap (LABOR) technique for recurrent midshaft and proximal hypospadias across multiple centres. PATIENTS AND METHODS: A retrospective review was conducted of patients undergoing LABOR repair for recurrent/complicated mid-penile and proximal hypospadias between 2014-2024 in three centres across two continents. Patients with severe curvature requiring urethral plate division or inadequate penile skin were excluded. PRINCIPLE OF THE TECHNIQUE: Two glandular wings are mobilized. The lateral penile skin is mobilized and advanced, medially, maintaining its blood supply and sutured to midline skin and folded as an onlay flap to reconstruct the neourethra to the glans tip. RESULTS: Among 397 referred patients, 97 patients met the inclusion criteria. Median age was 3 years (range 22 months-49 years). Follow-up ranged from 1-11 years. Forty-four patients (45%) maintained long term follow up more than 5 years. Complete healing without complications occurred in 77 patients (79%). Complications occurred in 20 patients (21%) including: glans dehiscence (8%), fistula (9%), and meatal stenosis (3%). All were successfully corrected with a single procedure. CONCLUSION: LABOR is an effective option to correct recurrent mid-penile and proximal hypospadias without severe chordee with acceptable complication rates (21%) and favourable long-term outcomes.