Surgical management of hypospadias cripples

Abstract

Purpose We retrospectively evaluated our results in patients who were referred to us as hypospadias cripples. Material and methods Over the last 17 years (1988-2005) more than 110 patients were referred to us after failure of multiple hypospadias repair. Out of those we considered 28 children and adolescents with the ages from 8 months to 15 years to be hypospadias cripples. All patients had from 2 to 5 surgical attempts prior to the referral. Patients were divided into two groups. The first group of 5(25%) patients underwent multiple staged repairs and a second group of 23(75%) had a single stage repair. In the first group all patients had a chordee and meatus was located on the proximal part of the penis. In the second group the meatus was located on the midshaft in 4 and in the proximal part in 19 patients. In the second group 14(60.8%) children had penile chordee. Chordee was repaired by excision of the scar tissue and dorsal plication of the tunica albuginea. Results Major complications included breakdown of the repair, multiple fistulas and urethral stricture, while minor complications included small fistula, meatal stenosis or unsatisfactory cosmetic outcome. The results are presented in the table. Groups Type of surgery N° Major complications Minor complications Revision First Staged repair 5 1 1 1 Second Bladder mucosa graft 2 - - - *OPIF (dorsal skin) 10 2 3 2 **TPIF (Dorsal skin) 3 1 1 - *OPIF (lateral skin) 4 1 2 1 Thiersh-Duplay 4 - 1 - All procedures 28 5(17.8%) 8(28.5%) 4(14.2%) *OPIF: Onlay Pedicled Island Flap **TPIF: Tubularized Pedicled Island Flap Conclusions Our data show that there is a place for the use of local penile skin flap with a good vascular supply in the treatment of hypospadias cripples. We prefer Thiersh- Duplay repair in patients with a wide ventral plate, which appears healthy. However the percentage of the complications is relatively high and some patients need repeat revisions in order to achieve good functional results.