Application of combined penile and scrotum skin flap in reoperation for failed hypospadias repair

Abstract

Objective To explore the application of combined penile and scrotum skin flap in the reoperation process for operation failure cases with hypospadias. Methods A retrospective analysis was performed with the inclusion of 15 failure cases with hypospadias who received combined penile and scrotal skin flap treatment for reoperation from January 2013 to December 2015 in the First Affiliated Hospital of Guangxi Medical University.These cases aged from 7 to 15 years old, with a median age of 10.2 years old.Among them, a 3rd operation was performed in 4 cases, 4th operation in 5 cases, 5th operation in 4 cases, and 6th operation in 2 cases.The procedure of Onlay island flap urethroplasty+ tubularized incised plate (Onlay+ TIP) urethroplasty was performed in 4 patients, and the other 11 cases were treated with urethral mouth basal vascular skin tube urethroplasty (Mathieu)+ TIP urethroplasty.F8 or F10 silicone balloon catheter were used as stent in new urethra, outer dressing after operation was replaced every 2 to 3 d, the outer dressing was demolished 6-8 d after operation. Results All patients were followed up after surgery until March 20, 2016, the follow-up time was 4-26 months.In these 15 patients, the success rate of operation was 86.7%(13/15 cases), among them, 3 cases were success and 1 case was failed in Onlay+ TIP group, and 10 cases were success and 1 case was failed in Mathieu+ TIP group.The patients with successful operation were with beautiful appearance of the penis, normal position of the meatus urinarius and normal urination.No peristome of urethra, urethrovaginal fistula or urethral diverticulum was found after surgery.However, urethral cracking of the glans of penis appeared in 2 operation failed patients, and the orificium urethrae externum was low-set, and urethroplasty was needed 1 year postoperatively. Conclusions For some failure cases with hypospadias showing suitable anatomy conditions, Onlay+ TIP or Mathieu+ TIP combined with penile and scrotal flap may be a good choice for the completion of reoperation. Key words: Hypospadias; Urethroplasty; Reoperation