Emerging role of preputial vascular pattern and postoperative microvessel density in cases of proximal hypospadias: A pilot study.

Abstract

Understanding of anatomical vascular patterns and anatomy of prepuce is critical for a good outcome in hypospadias surgery. A well-vascularized neourethral and preputial flaps used for repair are exceptionally important for a successful outcome, especially in cases of proximal hypospadias undergoing one-stage procedures. To evaluate the vascular anatomy of prepuce in cases of proximal hypospadias and to evaluate microvessel density (MVD) by immunohistochemistry and its correlation with postoperative complications. This was a prospective observational study done between November 2013 and March 2015; 33 cases of proximal hypospadias undergoing surgery were evaluated for vascular pattern by intraoperative cold light method and postoperatively by MVD. Twenty-six cases with a predominant vessel pattern were identified (18 of type 1, 7 of type 2, and 1 of type 3), while seven cases had a reticular pattern (type 4) on cold light transillumination. The mean MVD in cases with predominant vascular pattern (Type 1-3) was 64.83. In cases of Type 4 pattern, mean MVD was found to be low 55.57 (P = 0.37). Patients who underwent single-stage surgery and developed postoperative complications had a low MVD score (mean 45.88, P = 0.040). Cold light transillumination is an effective perioperative test, reliable in the assessment of preputial vascularity. There is no statistically significant difference between the MVD of predominant vascular pattern and reticular pattern signifying that MVD may or may not be good in a given vascular pattern. MVD can be a helpful marker in assessing prognosis of repair in proximal hypospadias.