Comparative study of one-stage and partial staged urethroplasty using transected urethral plate plus TIPF for severe hypospadias: a one-doctor experience

Abstract

To explore the application value of staged urethroplasty by tubularization of reconstructed urethral plate using preputial island flap for severe hypospadias. We retrospectively analyzed 91 cases with severe hypospadias, using one-staged and two-staged urethroplasty by tubularization of reconstructed urethral plate using preputial island flap. In one-staged group, the age of surgery was 7 months to 12 years old; the length of urethral defect was 3–5cm; the diameter of glans was 1.0–1.4cm. In two-staged group, the initial operation time was 7 months–12 years old; the length of the urethral defect was 3–5cm and the diameter of the glans was 0.8–2.5cm. There was no significant difference in the age of surgery, glans diameter and length of urethral defect between the two groups. In the one-staged group, 18 cases had urinary fistula, 1 case glans dehiscence, 1 case urethral diverticulum, and 1 case had urethral diverticulum and glans dehiscence at the same time. All of them were addressed by urinary fistula repair/urethroplasty. There was no urinary fistula after secondary urethroplasty in the two-staged group. Four cases had new urethral dehiscence at the glans. 2 of them were successfully managed by reoperation, and the other’s parents did not agree to reoperation. The success rate of the one-staged operation group was 62.50%, and the two-staged group was 88.57%. There was a statistically significant difference in the success rate between the two groups. Two-staged urethroplasty by tubularization of reconstructed urethral plate using preputial island flap can significantly reduce the incidence of urethral fistula for severe hypospadias, but may increase the number of operations in children who do not need staged surgery.