Treatment of hypospadias in children with urethral plate combined with one crescent flap

Abstract

Objective To investigate the clinical effect of urethral plate combined with unilateral crescent flap in the treatment of hypospadias in children. Methods The clinical data of 14 cases of hypospadias treated from March 2017 to March 2018 were retrospectively analyzed, with average age of (3.3±2.1) years.The external urethral orifice was located in the middle and distal part of the ventral side of the penis, with mild and moderate bends of the penis.The prepuce was piling up on the penile dorsal side, the ventral skin was deficient, and there was no concomitant disease such as penis scrotum transposition or cryptorchidism.All children were primarily treated with urethroplasty with urethral plate and one crescent flap.One side of the free urethral plate had a crescent superficial fascia, which was used as the new urethral material together with the urethral plate. By design, the urethra sutured deviating from the midline.The external urethral orifice was formed by trimming the anterior opening of urethra in the form of shallow V shape, and the new urethra was covered with the dorsal fleshy vascular pedicle. The pterygoid flap of the penis was sutured to form the penile head, and the foreskin was cut to cover the body of the penis.The specimens were taken for HE staining. Results The operation was successfully completed in 14 children.The length of the penis was measured before it is stretched out.The penile length was(3.5±0.5)cm, the penile diameter was(1.2±0.3) cm at the coronal sulcus, and the diameter of the tortoise head was(1.5±0.3)cm at the pterygoid.The width of urethral plate was(0.6±0.1)cm.Remeasurement was performed after complete correction of penile bending deformity.The length of the penis was(3.5±0.5)cm, and the urethral defect was(1.7±0.7)cm.According to Barcat method, there were 2 cases of coronal sulcus type, 7 cases of anterior penile type and 5 cases of middle penile type. The results of HE staining showed that the number of blood vessels in the dorsal prepuce and fascia was(8.5±2.1), dorsal foreskin plate was (5.1±1.6), ventral prepuce internal plates was(7.6±1.8), and ventral outer prepuce plates was(4.8±1.6). The number of superficial fascia vessels and deep fascia vessels were(10.3±1.4)and (4.2±1.7). The analysis of variance showed that there was significant difference in the mean number among groups(P=0.036), which was compared with each other by SNK-q test.The number of fasciae in dorsal prepuce was the most abundant, there was significant difference between dorsal and outer prepuce(P=0.033), and there was also significant difference with ventral prepuce(P=0.047). But there was no significant difference between the two groups(P=0.326). There was no significant difference in the number of blood vessels between the dorsal and ventral prepuce(P=0.682). The number of superficial fascia vessels near the skin was significantly more than that of deep fascia(P=0.037). On the transverse plane, there are more branches of the superficial fascia to the urethral plate at the junction of the ventral external plate and the urethral plate.All 14 cases were followed up for 3 to 9 months with an average of(5.4±2.1)months.The penis was straight and satisfactory, urethral orifice was not cracked, urination was laborious and not forked, and there was no fistula.One patient with middle penile type developed postoperative infection and was controlled after anti-infective treatment.One patient with anterior penile type had slight urination after operation, but had no difficulty in urination. F6 metal urethral dilator was used to dilate for 2 months, and the urination was normal. Conclusion Urethral plate combined with crescent flap urethroplasty for hypospadias has a satisfactory appearance and fewer complications.It provides an optional operative method for the children who need no transection of urethra plate to straighten the penis, especially for the poor development of the penis and the insufficiency of the new urethral materials.The superficial fascia tissue on both sides of the urethral plate is an ideal material for the new urethra because of its abundant blood supply adjacent to the urethral plate and direct vascular connection. Key words: Urethral plate; Flap; Crescent; Hypospadias