Results of Onlay Preputial Flap Urethroplasty for the Single-Stage Repair of Mid- and Proximal Hypospadias

Ricardo González,Anja Lingnau,Barbara Magda Ludwikowski

doi:10.3389/fped.2018.00019

Ricardo González, Anja Lingnau + Show 1 more

Open Access

https://doi.org/10.3389/fped.2018.00019

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Abstract

To report current results of preputial flap onlay urethroplasty using the principle of the total preputial flap (TPF) for the one-stage repair of mid- and proximal hypospadias. This study was a retrospective chart review of patients in a prospectively kept database of all hypospadias operations performed at two institutions from January 1 2011 to August 2017. Inclusion criteria: all patients who underwent hypospadias repair using a preputial only flap urethroplasty based on the principle of the TPF. Demographic data, duration of follow-up, complications, and reoperations were recorded. A successful result was considered to be a straight penis, a glanular meatus, and absence of voiding symptoms. Whenever possible an uroflow was obtained during the follow-up visits. Forty-nine children met the inclusion criteria. All patients had marked penile curvature. Three patients had chromosomal abnormalities. The mean age at the time of surgery was 22 months (11-110) and the mean duration of follow-up 23.4 months (1-79). In 48 cases, the urethral plate could be preserved without dividing it. The penile curvature was corrected with chordectomy alone in 10 patients, 38 required a dorsal plication of the tunica albuginea, and 1 required an additional ventral dermal graft. In 38 patients (77.5%), the initial operation was successful, and no further operations were needed. There were eight urethrocutaneous fistulas, three dehiscences of the glans approximation. One patient suffered a wound infection and partial loss of the flap. One-stage repair of mid- and proximal hypospadias preserving the urethral plate and using a TPF for the urethroplasty and coverage of the ventral penis is successful in 77.5% of cases. Complications in the remaining patients were easily managed or did not require treatment. Compared to a planned two-stage approach, the technique described in this report resulted in significantly fewer procedures till complete resolution of the problem.

Highlights

The surgical repair of hypospadias involving an urethroplasty and repair of a ventral curvature greater than 20° [1, 2] after releasing the ventral penile skin is often referred to as repair of middle and proximal or posterior hypospadias [3]
Based on our previous experience and given the fact that some literature reports equivalent results with various techniques, we have continued to use the technique described by one of us more than 20 years ago [15], which consists of avoiding the division of the urethral plate in the majority of the cases and reconstruction of the urethra with an onlay flap derived from the outer layer of a total preputial flap (TPF) and when the ventral skin deficiency required it, a double face preputial flap was used [16]
The results obtained in this series of patients are comparable to previous reports using the onlay urethroplasty [9]

Summary

Introduction

The surgical repair of hypospadias involving an urethroplasty and repair of a ventral curvature greater than 20° [1, 2] after releasing the ventral penile skin is often referred to as repair of middle and proximal or posterior hypospadias [3]. The correction of these malformations continues to challenge surgeons, and there is no agreement as to the best technique for its correction. We report our experience with the abovementioned technique in consecutive cases operated by two surgeons (Barbara Magda Ludwikowski and Anja Lingnau)

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Conclusion