One Stage Urethroplasty in Severe Hypospadias -Buccal Mucosa Inlay with Penile Island Skin Flap Onlay

Abstract

Purpose Severe forms of Hypospadias are usually associated with chordee and short or even absent urethral plate that result in a small and curved penis. In this case, the urethral plate should be divided for penile straightening and lengthening. In such cases the missing urethral plate needs to be augmented. Material and Methods We present the case of a 14 month old boy with a perineal Hypospadias, a 90° ventral penile curvature and a bifid scrotum.After completion of penile degloving, artificial erection reveals a severe ventral penile curvature.The short urethral plate is mobilised in the plane of Buck’s-Facia. The urethral plate is divided at the coronal level.The dorsal neurovascular bundle is carefully mobilised. With another artificial erection, the point of the maximal curvature is revealed and the intended correction marked with an Ellis-Clump.In order to straighten the penis, the marked area is incised longitudinally and sutured transversally. Renewed erection demonstrates the straightened penis.The distance between the original hypospadic meatus and the distal end of the divided urethral plate shows a 4cm gap that needs to be bridged.Buccal mucosa is harvested from the inner cheek and brought to the ventral aspect of the penis to be used as an inlay graft to fill in the gap of the missing urethral plate.After complete fixation of the buccal mucosa, the inlay is quilted to the tunica albuginea.Dorsal penile and preputial skin was used for creating the longitudinal island flap.The island flap is transposed ventrally with the buttonhole technique to be used as the onlay flap.The glanular wings are trimmed and the glans reconstructed.The bifid scrotum is corrected in the same session. Results A severe Hypospadias was corrected as a one-stage-procedure. No complications occurred. Conclusions Combined longitudinal island skin flap and buccal mucosa graft could be a good choice for urethral reconstruction in most severe Hypospadias repairs.