Five years' experience of double faced tubularized preputial flap for penoscrotal hypospadias repair in pediatrics

Abstract

The success of techniques for proximal hypospadias repair using vascularized preputial flaps has led to their wide application for the last decade. From these techniques, transverse tubularized preputial flaps are particularly attractive. However, high reported rate of complications, including recurrence and urethro-cutaneous fistulae are still challenging the success of these techniques, probably related to vascular insufficiency for the lengthy neourethra. Therefore, many surgeons trying to improve the outcome by utilizing the unique vascular benefits of double faced preputial flap. the present study tries" to evaluate double faced tubularized preputial flap technique for incidence of complications, in comparison with the standard ventral tubularized preputial flap, and to evaluate also surgical outcomes regarding the clinical urinary function and cosmetic results. This was a prospective controlled randomized study, included 160 patients with peno-scrotal hypospadias, conducted at Al-Azhar University hospitals, from January 2014 to January 2019. All patients submitted to one-stage repair. Eighty patients underwent double faced tubularized preputial flap technique (group A) and 80 patients underwent standard ventral preputial tubularized flap technique (group B). Different complications were reported in 12 patients (15%) in group A, compared to 20 patients (25%) in group B. The difference between the complication rates in both groups was statistically significant. 152 of 160 children (95%) had good clinical urinary functional outcomes (short micturition time, good urinary stream without straining or post voiding dribbling) and satisfactory cosmetic results obtained by parents' questioner at follow up visits. This article presents an evaluation of double faced tubularized preputial flap technique in comparison to standard ventral preputial tubularized flap technique (Duckett) in one-stage peno-scrotal hypospadias repair, regarding surgical outcomes, rate of complications, clinical urinary function and satisfactory cosmetic results. Double faced tubularized flap repair is a good option to reconstruct penoscrotal hypospadias after correction of chordee which have fewer complications and also shows that transferring the tube with its skin appears to achieve better ventral skin covering. Double faced tubularized preputial flap technique seems to be a superior option, that provide better vascular supply with better results when compared to standard ventral preputial tubularized flap in one-stage peno-scrotal hypospadias repair, with reported fewer complications, better urinary function and good cosmetic results.