STAG versus STAC in Proximal Hypospadias

STAG and STAC are not simply two-stage versus three-stage repairs.They represent two different ways of sequencing wound healing in severe proximal hypospadias.In STAG, curvature correction, urethral plate transection, ventral corporal lengthening, and graft placement occur in the first stage.In STAC, straightening and shaft closure occur first. Grafting is delayed. Tubularization is delayed again.This episode reframes STAG versus STAC as a question of biological timing: which wound should heal first, and which wound should not be overloaded?We discuss ventral corporotomies, graft take, graft contracture, glans configuration, repeat artificial erection, tubularization readiness, and why operative documentation should describe the healing problem rather than only the named technique.This episode is part of Season 4 of Pediatric Urology Academy: Hypospadias — Anatomy, Judgment, and Reconstruction.Evidence basis: Campbell Chapter 56 describes STAG as a Bracka modification involving plate division, glans bed creation, graft quilting, compression, later tubularization, and warns that grafts placed over corporotomies may contract; it also describes STAC as delaying graft placement until after straightening and closure. Recent STAG-versus-STAC reports and reviews describe lower graft and urethroplasty complications with STAC in expert-center experience, but the evidence remains non-randomized and center-dependent. A 2026 JPU paper also evaluates three corporotomies during STAC for severe curvature, reinforcing the technical importance of repeated artificial erection and curvature verification.