Urethroplasty in the distal penile segment using flap for the staged correction of severe hypospadias

Abstract

To discuss the applicatioen of flap for the urethroplasty in the distal penile segment in the staged correction of severe hypospadias. From Oct. 2004 to Aug. 2014, 25 cases with severe hypospadias were treated by staged urethroplasty for urethra reconstruction. The urethral meatus were located at peroscrotum in 4 patinets, at scrotum in 8 patients and at perineum in 13 cases. At the first stage, the urethral plate was divided and chordee was corrected. Then tubularized transverse island flap was used to prefabricate partial distal urethra. The defective urethra was repaired by using the Thiersch-Duplay principle at the second stage. All patients completed both stages of the operation. The follow-up duration was 6-72 months (average, 24 months). In the first-stage, the modified tabularized transverse preputial island flap was performed on 10 patients, whereas the modified preputial double-faced island flap was performed on the other 15 patients. All of the prefabricated partial distal urethras had no evidence of stenosis or scarring. The result of the second-stage procedure was a complete penis with integrated urethral. All patients were satisfied with cosmetic and functional results. Neither stricture nor diverticula was observed. A good urinary stream during the urination was achieved in 19(19/ 25, 76%) patients. Five cases (5/25, 25%) developed urethrocutaneous fistula and one cases developed meatal stenosis (1/25, 4%) after the second stage repair. Staged urethroplasty using flap is a good choice for severe hypospadias. The successful rate is relatively high with good cosmetic and functional results.