One-Stage repair of hypospadias using the modified prepucial island flap technique: Experience with 200 cases

Abstract

Background: Surgical repair of hypospadias has taxed the skills of surgeons the world over. One-stage repair is preferable because it decreases operative trauma, allows use of virgin unscarred tissue, decreases number of hospitalizations, and hence is more economical than two-stage repairs. During the last 7 years, the author has managed 200 cases of hypospadias and their complications in a tertiary care service hospital. This study aimed to evaluate the outcomes of using modified onlay island flap technique in the repair of hypospadias with a narrow urethral plate. Patients and Methods: In this prospective study conducted between June 2008 and June 2015, we performed modified onlay island flap procedure for the repair of hypospadias with a narrow urethral plate – less than 7 mm. This technique was used for all types of hypospadias with minimal or no chordee except penoscrotal. We did not require any tunica plication in our study. Results: Two hundred patients with age ranging from 3 years to 10 years (average 5 years) underwent modified onlay island flap repair; all had a narrow urethral plate of less than 7 mm; 30 (15%) had mild chordee. Meatus was located in coronal in 10 (5%) cases, subcoronal in 120 (60%), midpenile in 50 (25%), and proximal penile in 20 (10%) patients. Chordee was corrected with degloving only in 30 (15%) patients. Complications were meatal stenosis in none and urethrocutaneous fistula in 10 (5%) patients. Mean follow-up duration was 12 months. Conclusion: This technique offers acceptable results regarding meatal stenosis, urethrocutaneous fistula, along with good aesthetic outcome.