Long-Term Results of Preputial Reconstruction in Selected Cases of Hypospadias

Abstract

Purpose To evaluate the long-term results of preputial reconstruction (PR) (instead of circumcision) in selected cases of hypospadias repairs. Material and Methods 216 consecutive primary hypospadias repairs performed before 01/01/2000 by 2 pediatric urologists in 1 institution were identified; 9 were lost for FU, the remainder had a mean FU of 93 (minimum: 60) months. PR was performed in all cases where this was both technically feasible and the parent's preference. Types of hypospadias repair were MAGPI in 98, Mathieu in 32, TIP in 26, onlay in 49 and 2-stage in 2 cases. PR was performed in 128 of 207 cases (62%); This was after MAGPI, Mathieu, TIP, Onlay and 2-stage type repairs in 85(87%), 21(66%), 20(77%), 2(4%) and 0(0%) repectively. Results Three specific types of complications can occur after PR which are avoided by primary circumcision: dehiscence of the PR, formation of a preputial fistula ( = minor partial dehiscence, not communicating with the urethra) or syptomatic / fibrotic phimosis. In this series, 16 boys (8%) had a specific PR-related complication leading to re-operation in 11(5%): 8 preputial fistulae (1 circumcision; 5 fistula-repairs; 2 no intervention) and 8 symptomatic and/or fibrotic phimosis (3 circumcisions; 2 preputioplasties; 3 conservative management). No preputial dehiscence occurred. No significant differences in PR-related complications were seen after different types of hypospadias repairs. The majority of PR-related complications occured during the first year after hypospadias repair. In the remaining 112 boys, the prepuce was fully retractible in 110 and partially retractible in 2 (without fibrosis or symptoms) at the last FU visit. Our results are comparable to the very scarce previous literature on this subject which has upuntill now only presented short-term results. Conclusions Preputial reconstruction is feasible in over 60% of hypospadias repairs (if this is the patient's/parent's preference) at the cost of a limited number of additional complications (8%) and re-operation rate (5%).