PD22-09 RESURFACING THE PENIS OF THE HYPOSPADIAS CRIPPLE

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Urethral Reconstruction (including Stricture) III1 Apr 2015PD22-09 RESURFACING THE PENIS OF THE HYPOSPADIAS CRIPPLE Mina Fam and Moneer Hanna Mina FamMina Fam More articles by this author and Moneer HannaMoneer Hanna More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1451AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES After the creation of a neourethra in patients with multiple failed hypospadias repairs (hypospadias cripples), resurfacing the penis with healthy skin is a significant challenge because local tissue is often scarred. Without adequate coverage of healthy skin, there is an increased risk of repair breakdown and poor cosmetic results. In our series, the use of a healthy scrotal fascio-cutaneous flap as well as the use of tissue expanders served as a reliable means of resurfacing the penis after complex repairs where there is a lack of healthy local tissue. METHODS We retrospectively reviewed 203 patients referred after multiple unsuccessful hypospadias repairs from 1989 to 2013. 58/203 patients did not have adequate healthy local penile skin to resurface the penis after urethroplasty. Scrotal skin was used to resurface the penis in 54/58 patients. Of these 54 patients, 50 had a scrotal fascio-cutaneous rotational flap and 4 had a Cecil two-stage repair. 6/58 underwent tissue expansion of the dorsal penile skin over a 12-16 week period prior to penile resurfacing. 2/58 patients underwent scrotal skin resurfacing and subsequent tissue expansion for their reconstructions. RESULTS Patient age ranged from 4-38 years old and the number of prior operations ranged from 3-24 operations. Follow-up ranged from 6 months to 22 years. 56/58 (96.5%) patients had successful resurfacing of the penis with scrotal skin, tissue expanders or a combination of both approaches. 5/54 (9.3%) patients who underwent penile resurfacing with scrotal skin developed post-operative cyanosis of the flap. 3/5 patients with cyanosis were salvaged with nitroglycerine ointment. After long-term follow up, 10/54 (18.5%) patients with scrotal skin resurfacing underwent flap revision due to minor complications such as scarring, presence of a “dog ear” and penoscrotal webbing. 6/10 patients who underwent flap revision required simultaneous depilation of a hairy flap. All 6 patients who underwent tissue expansion had successful skin flap reconstruction without complication. CONCLUSIONS A rotational scrotal fascio-cutaneous flap is typically well-vascularized and therefore lends to successful penile resurfacing after urethroplasty. In select cases, local expansion of dorsal penile skin provides a skin flap with excellent texture and pigmentation to resurface the penis. In our experience, the use of scrotal skin flaps, tissue expansion of the dorsal penile skin or a combination of both serve as reliable approaches in resurfacing the penis in almost any hypospadias cripple lacking healthy local skin. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e479 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mina Fam More articles by this author Moneer Hanna More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...