Combination of Tubularized Island Flap and Ventral Skin Flap Techniques in Single-Stage Correction of Severe Proximal Hypospadias

Abstract

Objectives: To evaluate the success of the combined tubularized island flap (Duckett technique) and Thiersch-Duplay techniques in one-stage correction of proximal hypospadias. Methods: Thirty-four patients underwent surgical treatment for penoscrotal hypospadias in the last 9 years. Combined tubularized island flap (Duckett technique) and tubularized ventral skin (Thiersch-Duplay) procedures were performed in each case. The proximal urethra was repaired by the Thiersch-Duplay technique through the base of the phallus, and distal urethral repair was conducted via the tubularized island flap procedure. Results: The follow-up lasted from 5 months to 6 years (mean 4.1 years). The overall complication rate was 26%, but no recurrent chordee was detected. Recurrent fistulae were noted in 7 patients (20.5%). Anastomatic stricture was noted in 3 patients (8.8%). Conclusion: A combination of Duckett’s preputial tube and the Thiersch-Duplay procedure was employed to treat 34 cases of severe hypospadias, with a success rate of 74%. In our procedure, the island flap tube is relatively short. Oblique anastomoses of proximal and distal tubes were made, and the pedicule of the flap supported the neourethra following successful interventions. Because of the low complication and high success rates, this combination of two procedures is recommended for repair of severe proximal hypospadias.