A strategy for repairing moderately severe hypospadias using onlay urethroplasty versus onlay-tube-onlay urethroplasty

Abstract

Objectives Moderately severe hypospadias can be repaired by a simple onlay island flap procedure with penile dorsal plication in most patients. However, when the penile curvature could not be corrected, and the urethral plate could not be preserved by the procedure, a combined procedure of onlay and tubularized island flap is subsequently needed. Methods Onlay urethroplasty was performed to repair hypospadias in 39 patients with hypospadias. However, the combined procedure (onlay-tube-onlay urethroplasty) was performed on 6 patients who had severe penile curvature even after skin degloving. Results Hypospadias was repaired successfully without complications in 30 (90.9%) of the 33 patients by conventional onlay urethroplasty alone. Of the 6 patients who underwent onlay-tube-onlay urethroplasty, 1 patient developed fistula and 1 developed meatal stenosis, for a success rate of 66.7%. The complications in all patients were later resolved. Conclusions We recommend switching to onlay-tube-onlay urethroplasty when the attempt to repair moderately severe hypospadias by the simple onlay procedure has to be abandoned, and the urethral plate needs to be divided.