A modified two-stage procedure strategy treat severe hypospadias with preputial flap

Abstract

Objective To investigate the effect of a modified preputial flap urethroplasty in two-stage treatment of severe hypospadias. Methods The clinical characteristics of the severe hypospadias patients (41 cases) who underwent the staged urethroplasty by using the procedure of preset urethral plate with preputial flap from January 2015 to December 2016 were analyzed retrospectively. We used a modified method (modified group, 23 cases ): Form the distal urethra with the transected distal urethral plate by using tubularize incised plate (TIP) procedure during the first stage operation, after completely straightened the penis, urethral plate was preseted with transverse preputial flap at the penis shaft. While in the traditional group (18 cases), urethral plate was preseted with preputial flap by using Bracka procedure after transecting urethral plate. The corresponding missing part of urethra underwent urethroplasty at the second stage operation six months later. The patients in the modified group were 9 to 18 months old, and the median age was 13 months; meatus were located at the penis shaft in 10 cases, scrotum in 12 cases, perineum in 1 case. The patients in the traditional group were 9 to 18 months old, and the median age was 13 months; meatus were located at the penis shaft in 6 cases, scrotum in 10 cases, and perineum in 2 cases. There was no statistic difference in age and meatus position between the two groups. Results During the first stage operation, distal urethra was repaired by 13-19 mm, with an average of (14.5±1.3) mm, and the proximal urethra was repaired by 0-6 mm, with an average of (3.1±2.4) mm at the modified group. While at the traditional group, the length of proximal urethra was repaired of 0-9 mm, with an average of (5.6±2.9) mm. The urethral length required for reconstruction was measured during the second stage operation, with an average of (26.3±4.4) mm in the modified group and (40.5±3.3) mm in the traditional group (P 0.05). Conclusions The modified staged preputial flap method shorten the new forming urethra by making full use of its own materials at the second stage operation, which was helpful to reduce complications. Key words: Hypospadias; Staged repair; Preputial flap; Urethral plate