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In parts of Africa, routine circumcision is practised and sometimes even on children with hypospadias. The lack of preputial foreskin renders urethroplasty more difficult and often requires to use of a mucosal graft as described by Bracka.

Our experience of proximal hypospadias repair using the Cloutier–Bracka technique at the Gynaeco-Obstetric and Paediatric Hospital, Yaounde-Cameroon