One-stage repair with foreskin pedicle island flap plus preserving urethral plate urethroplasty for hypospadias

Abstract

Objective To explore the indications, techniques and complications of foreskin pedicle island flap plus stripping and preserving urethral plate urethroplasty in the treatment of hypospadias. Methods Retrospective reviews were conducted for 80 patients undergoing proximal hypospadias repair with tubularized transverse preputial island flap urethroplasty (Duckett) plus stripping and preserving urethral plate urethroplasty (Onlay) between Jun. 2007 and Jan. 2013. The age range was 1-9 years. The types were proximal shaft (n=53), scrotal (n=21) and perineal (n=6). And cosmetic and functional assessments were made during a follow-up period of 6-72 months. Results The mean length of neourethra was 3.8 (2.5-5.0) cm. The straightening and appearance of penis were satisfactory and meatus was located postoperatively at normal anatomical position. Sixty-two patients (77.5%) had better curative efficacy without complications. The maximum flow rate (Qmax) was (7.9±0.4) ml/s and the average flow rate (Qave)(5.2±0.3) ml/s. Fistula of 12 cases was repaired. Stricture of urethral external orifice was relieved after urethral dilation in 2 cases. And 4 patients of diverticular distension were reoperated. Conclusions Fully stripping and preserving urethral plate decrease the occurrence of complications, especially stricture and permitting penile straightening. This procedure restores good function and normal appearance of penis and it may be used for urethroplasty of proximal hypospadias with a wide and healthy urethral plate. Key words: Hypospadias; Surgical flaps; Urologic surgical procedures, male