Modified double face preputial flap urethroplasty for single-stage repair of proximal hypospadias.

Abstract

Background:There is an ongoing pursuit to decrease complications of hypospadias surgery. We studied a modification to the double onlay preputial island flap, whereby an additional tunica vaginalis layer was used.AimsWe aim to study the efficacy, complication rates and outcomes of the modified double onlay urethroplasty technique.Materials and Methods:This study adopts an observational consecutive study design. From 2014 to 2019 the modified preputial double onlay urethroplasty technique was used in 30 patients. Selection criteria was severe hypospadias operated on using the technique studied in a single stage procedure. We excluded perineal hypospadias, cripple hypospadias, and combined procedures. The operative technique used involved a layer of preputial flap for the neourethra followed by a layer of tunica vaginalis followed by another preputial flap layer over the ventral penile skin defect.Results:Patients were followed up for a mean of 2.04 years. There were 11 (36.67%) complications. Urethrocutaneous fistulas occurred in 3 patients (10%). There were 3 cases (10%) of glanular dehiscence and 1 (3.3%) diverticulum. No correlation was found between operative age, hypospadias type, or chordee approach and complications. Short second surgeries were needed in 7 patients (23.3%).Conclusion:The modified technique used in this study yielded good cosmetic and functional results. Complication rates were in line with the lower ranges reported by the literature for the standard double onlay preputial flap technique.