The Single Stage Dorsal Inlay Skin Graft for Hypospadias Reoperations: Long-Term Follow-Up

Abstract

PURPOSE Despite high success rates for primary hypospadias repair, some patients still require multiple sessions for ultimate functional reconstruction. We report our long-term experience with single stage dorsal inlay urethroplasty using skin grafts for complex hypospadias reoperations. MATERIAL AND METHODS 35 patients (mean 13.8 years) with failed hypospadias surgery (mean 4.2 times) were included. Indications comprised fistulas, strictures, diverticula, and repair breakdown. The urethral plate had been removed or was scarred in all patients. After excision of fibrotic tissue a free penile or groin skin graft was sutured and quilted to the corpora cavernosa. The neourethra was tubularized followed by glanuloplasty in a single stage. Clinical outcome was considered a failure when any postoperative instrumentation was needed. RESULTS Penile skin was used in 31 and inguinal skin in 4 cases.The average graft length was 4.87 cm. Initial graft healing was successful in all cases. We did not note complications from the graft donor sites. After a mean follow up of 55.73 +/- 18.26 months 5 patients underwent redo surgery leaving a complication rate of 14.3 %. Urethral stricture of the proximal anastomosis was the most frequent finding. Single internal urethrotomy was sufficient for 2 boys whereas 2 finally required another urethroplasty using the same technique. CONCLUSIONS This single stage approach using dorsal inlay skin grafts is a reliable method to create a substitute urethral plate for tubularization. Complication rates are equivalent to those of staged strategies with the advantage of only one hospital stay. Residual penile skin should be used as a graft donor site to optimize the outcome if available. Given the excellent long term follow-up, this approach represents a safe option for hypospadias re-operations even if the urethral plate or midline penile skin is grossly scarred.