Preservation of urethral plate spongiosum: technique to reduce hypospadias fistulas

Abstract

Objectives. Fistula remains the most common complication of hypospadias repair. Buried and well-vascularized suture lines reduce the incidence of fistula. We review the results of routine preservation and incorporation of the abortive spongiosum to prevent fistulas with the onlay island flap technique of hypospadias repair. Methods. Thirty-six consecutive boys underwent hypospadias repair with an onlay island flap during a 2-year period, with preservation and incorporation of the abortive spongiosum. The technique of using the abortive spongiosum in these children was reviewed. The age at surgery, preoperative meatal position, chordee presence, and neourethral length was noted. Results. The average age at surgery was 13.1 ± 18.5 months, with an average follow-up of 15.4 ± 6.7 months. The preoperative meatal position was midshaft in 15 boys, more proximal in 14, and more distal in 7 boys. Four boys required dorsal plication because of persistent chordee after skin takedown. The average neourethral length created with the onlay flap was 16.8 ± 7.6 mm. Complications occurred in 5 patients and included three diverticulae, one urinary tract infection, and one glanular adhesion. No fistula occurred in any patient. Conclusions. The abortive spongiosum is routinely obtainable with careful penile degloving. This technique provides a vascular tissue for coverage of the suture lines and reduces fistula formation.