Long-Term Results with A One-Stage Complex Primary Hypospadias Repair Strategy (The Three-in-One Technique)

Abstract

Purpose Complex primary Hypospadias repair that deserve urethral plate division is treated mostly in two steps, but not necessarily in two surgeries. Our aim in this review was to recheck our long-term results with a one-stage strategy we published in the past based on simultaneous reconstruction of the urethral plate with dorsal buccal mucosa graft and onlay transverse preputial flap anastomosis protected in the end by a tunica vaginalis flap (the three-in-one concept). Material and Methods We found 35 patients operated with primary scrotal, penoscrotal and perineal Hypospadias between March 2002 and June 2008. We reviewed all charts active in follow-up and made phone interviews for those not seen for the last 24 months. We investigated parameters such as UTI occurrence, fistula, residual curvature, meatal stenosis, urethral diverticula, urethral dehiscence, orchitis and parental perception. Results Surgical complications occurred in 11 patients (31%) and are listed: 4 meatal stenosis, 4 diverticula, 5 fistulas and 2 residual penile curvatures (total 42%). Meatal dilatation was successful in 2 cases that reflected in 2 fistula resolution. The reoperation rate was 25.7% and consisted mostly of simple procedures like fistula closure, meatotomy and complex diverticula repair in 3 cases. Two patients presented recurrent orchitis and UTI but were associated with infrequent voiding characteristics. End parental perception after treatment was excellent for 57% (20 patients) and good or acceptable for the rest. Conclusions We concluded that one-step strategy as here described is associated with 69% chance of one single operation without any complication to treat complex Hypospadias forms, whereas 25.7% will need a second repair. We recognize that meatal problems are mostly associated with fistula and diverticula and therefore we recommend a final acceptable proximal glandar opening that may not compromise the neourethra. Complex primary Hypospadias repair that deserve urethral plate division is treated mostly in two steps, but not necessarily in two surgeries. Our aim in this review was to recheck our long-term results with a one-stage strategy we published in the past based on simultaneous reconstruction of the urethral plate with dorsal buccal mucosa graft and onlay transverse preputial flap anastomosis protected in the end by a tunica vaginalis flap (the three-in-one concept). We found 35 patients operated with primary scrotal, penoscrotal and perineal Hypospadias between March 2002 and June 2008. We reviewed all charts active in follow-up and made phone interviews for those not seen for the last 24 months. We investigated parameters such as UTI occurrence, fistula, residual curvature, meatal stenosis, urethral diverticula, urethral dehiscence, orchitis and parental perception. Surgical complications occurred in 11 patients (31%) and are listed: 4 meatal stenosis, 4 diverticula, 5 fistulas and 2 residual penile curvatures (total 42%). Meatal dilatation was successful in 2 cases that reflected in 2 fistula resolution. The reoperation rate was 25.7% and consisted mostly of simple procedures like fistula closure, meatotomy and complex diverticula repair in 3 cases. Two patients presented recurrent orchitis and UTI but were associated with infrequent voiding characteristics. End parental perception after treatment was excellent for 57% (20 patients) and good or acceptable for the rest. We concluded that one-step strategy as here described is associated with 69% chance of one single operation without any complication to treat complex Hypospadias forms, whereas 25.7% will need a second repair. We recognize that meatal problems are mostly associated with fistula and diverticula and therefore we recommend a final acceptable proximal glandar opening that may not compromise the neourethra.