Prolonged and broadened plate plus Onlay flap urethroplasty

Abstract

Objective To summarize the experiences of hypospadias repair using prolonged and broadened plate plus Onlay flap urethroplasty. Methods A retrospective review of prolonged and broadened plate plus Onlay flap urethroplasty was performed from October 2015 to April 2016.Among 37 patients with primary hypospadias, the clinical types were penile (n=27) and penoscrotal (n=10). Urethral plate was resected for straightening out corpora cavernosa.All urethral plates measured ≥8 mm and all glans ≥14 mm in diameter.Urethral plate was preserved and penile skin degloved until root of penis.After fully straightening out, lengthway incision was made in the middle of urethral plate for broadening.Then sideling in the most obvious place of penis was bent for prolonging urethral plate.After indwelling catheter, partial urethra formed.Then a foreskin pedicel island flap was chipped and onlaid with urethral plate.Ventral superficial fascia was used as a second layer vascular cover over neourethra.Glansplasty was performed with suturing glans wings to obtain the esthetics of glans and meatus. Results All operations were performed successfully.The average operative duration was 77(65-95) min.The postoperative complications included urethral fistula (n=4, 10.8%) and urethral stricture (n=5, 13.5%). All 5 patients stayed in remission after 1-3 urethra dilatation.After a 3-month follow-up period, 3 cases (8.1%) were complicated by urethral fistula.There was no occurrence of urethral stricture or recurrent penile curvature.All of them had entopic and slitlike urinary meatus. Conclusions Prolonged and broadened plate plus Onlay flap urethroplasty is effective for severe hypospadias.With a low incidence of postoperative complications, this procedure may be easily performed.It is indicated when transecting urethral plate is required for penile straightening. Key words: Hypospadias; Urethroplasty; Complication