The Use of Tissue Expanders for Resurfacing of the Penis for Hypospadias Cripples

Abstract

To review our experience with tissue expanders for resurfacing the penis in selected cases of complex hypospadias repairs. We reviewed the medical records of 6 hypospadias male patients who underwent tissue expansion for phallic skin resurfacing. The patients ranged in age from 14-29 years of age at the time of placement of the tissue expander. All 6 patients had 5-8 failed surgeries and were "hypospadias cripples." In each case, the injection port was placed in the suprapubic area, whereas the tissue expander was placed under the skin on the dorsum of the penis. The tissue expanders were inflated slightly in the operating room and then subsequently at 2-week intervals over 12-16 weeks. At the point of maximum tissue expansion, the patients underwent reconstructive surgery and removal of the tissue expanders. Successful tissue expansion occurred in all 6 patients. The patients then underwent penile skin flap reconstruction of their penises. Two patients developed minor complications (1 urethrocutaneous fistula, 1 meatal stenosis), which were successfully corrected. Long-term follow-up ranged from 1-22 years. Successful phallus resurfacing with penile skin was achieved in all 6 patients. Patients who have undergone multiple attempted hypospadias repairs may lack a sufficient amount of healthy, unscarred penile skin for a successful outcome. These patients are therefore candidates for tissue expansion of the relatively normal skin usually found on the dorsum of the penis. In our experience, tissue expanders are a safe and effective method of acquiring genital skin for resurfacing in selected cases of hypospadias cripples and therefore should have a place in the surgical armamentarium of complex and redo-hypospadias repairs.