Onlay Island Flap Research Articles

Our 21-Year Experience with the Thiersch-Duplay Technique following Surgical Correction of Penoscrotal Transposition

Objectives: To assess surgical techniques applied after surgical correction of penoscrotal transposition and their complications. Methods: The medical records of 64 patients with a mean age of 4.1 years (range 1–24) who underwent surgical correction for penoscrotal transposition and subsequent Thiersch-Duplay urethroplasty in the last 21 years were evaluated retrospectively. Results: All cases underwent Thiersch-Duplay urethroplasty following reconstruction of penoscrotal transposition after a minimum interval of 6 months. Following Thiersch urethroplasty, 41 (64%) cases with successful outcomes had glandular meatuses. Of the remaining 23 (36%) patients 15, 7 and 1 patients underwent second operations for urethrocutaneous fistulas, meatal regressions and urethral diverticulum, respectively. Eleven of 15 patients underwent primary fistula repair and 4 patients, turnover fistula repair. These patients had glandular meatuses following fistula repair. Seven cases with meatal regression and breakdown of the neourethra were reoperated on by using double-face urethroplasty, onlay island flap urethroplasty and free-tube urethroplasty techniques. Finally, all patients had glandular meatuses. One patient with urethral diverticulum underwent successful diverticulum excision and meatoplasty. Conclusions: Thierch uretroplasty is the most commonly performed technique after surgical correction of penoscrotal transposition; however, additional procedures are needed for the management of its complications.

SHOULD WE STILL USE ONLAY ISLAND FLAP FOR PENOSCROTAL HYPOSPADIAS REPAIR?

You have accessJournal of Urology1 Apr 2008SHOULD WE STILL USE ONLAY ISLAND FLAP FOR PENOSCROTAL HYPOSPADIAS REPAIR? Luis H Braga, Armando J Lorenzo, Yaser El-Hout, Walid A Farhat, Darius J Bagli, Antoine E Khoury, and Joao L Pippi Salle Luis H BragaLuis H Braga More articles by this author , Armando J LorenzoArmando J Lorenzo More articles by this author , Yaser El-HoutYaser El-Hout More articles by this author , Walid A FarhatWalid A Farhat More articles by this author , Darius J BagliDarius J Bagli More articles by this author , Antoine E KhouryAntoine E Khoury More articles by this author , and Joao L Pippi SalleJoao L Pippi Salle More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)61196-9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "SHOULD WE STILL USE ONLAY ISLAND FLAP FOR PENOSCROTAL HYPOSPADIAS REPAIR?." The Journal of Urology, 179(4S), pp. 408–409 © 2008 by American Urological AssociationFiguresReferencesRelatedDetailsCited byWright I, Cole E, Farrokhyar F, Pemberton J, Lorenzo A and Braga L (2018) Effect of Preoperative Hormonal Stimulation on Postoperative Complication Rates After Proximal Hypospadias Repair: A Systematic ReviewJournal of Urology, VOL. 190, NO. 2, (652-660), Online publication date: 1-Aug-2013. Volume 179Issue 4SApril 2008Page: 408-409 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetricsAuthor Information Luis H Braga More articles by this author Armando J Lorenzo More articles by this author Yaser El-Hout More articles by this author Walid A Farhat More articles by this author Darius J Bagli More articles by this author Antoine E Khoury More articles by this author Joao L Pippi Salle More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparative Analysis of Tubularized Incised Plate Versus Onlay Island Flap Urethroplasty for Penoscrotal Hypospadias

Comparative Analysis of Tubularized Incised Plate Versus Onlay Island Flap Urethroplasty for Penoscrotal Hypospadias

Scrotal Reconstruction Using Rapid Intraoperative Tissue Expansion: A Preliminary Report

Extensive scrotal skin loss can pose a difficult management problem. In most cases delayed scrotal approximation is feasible due to the redundancy of scrotal skin. However, large defects usually require reconstruction using flaps or grafts. We present a novel technique of scrotal closure using rapid intraoperative tissue expansion to manage select extensive partial scrotal defects. Between January 1996 and April 2006, 3 patients underwent delayed closure using rapid intraoperative tissue expansion for approximately 75% scrotal skin loss. Intraoperatively the residual lateral scrotal and medial thigh skin, and subcutaneous tissues were dissected, creating bilateral cavities for the placement of round 300 cc tissue expanders. Gradual inflation for a total of 20 minutes allowed adequate tissue expansion of the 2 thigh flaps, enabling tension-free scrotal closure. Each patient was followed for 12 months. The resulting reconstruction provided a tension-free, cosmetically appealing scrotum with complete testicular coverage. There were no perioperative or postoperative complications. Although rapid intraoperative tissue expansion has been successfully used for the closure of facial and extremity defects, to our knowledge it has not been described for genital skin loss. Our experience suggests that this relatively simple method is a viable addition to the reconstructive armamentarium in a select group of patients with extensive scrotal skin defects that are not amenable to scrotal approximation alone.

MP-02.04: Can a slit-like meatus be achieved with the V incision sutured meatoplasty for onlay island flap hypospadias repair?

The transverse preputial onlay island urethroplasty is excellent for hypospadias repair of anterior hypospadias without chordee. Because a slit-like normal meatus could not be constructed in many patients who underwent the original onlay island flap repair, we applied a V incision sutured meatoplasty which Boddy and Samuel developed to provide a natural vertical slit-like glanular meatus for the Mathieu flip-flaps, to our onlay urethroplasty. We evaluated whether the V incision sutured meatoplasty is useful to the configuration of the constructed meatus for the onlay flap as well as the flip-flap.

Comparative Analysis of Tubularized Incised Plate Versus Onlay Island Flap Urethroplasty for Penoscrotal Hypospadias

Despite being the dominant technique for repair of distal hypospadias, application of the tubularized incised plate approach for penoscrotal hypospadias remains controversial. We report our experience with severe hypospadias, comparing tubularized incised plate to transverse island flap onlay urethroplasty. We retrospectively reviewed consecutive patients with penoscrotal hypospadias presenting between 1998 and 2006. Based on surgeon preference 35 children underwent tubularized incised plate and 40 underwent onlay urethroplasty. Penoscrotal transposition and degree of ventral curvature, type of ventral curvature repair, complication rate, postoperative uroflowmetry pattern in toilet trained patients and number of reoperations were compared between the 2 groups. Mean patient age at surgery was 17 months (range 9 to 91) for tubularized incised plate urethroplasty and 17.8 months (10 to 58) for the onlay procedure. Urethroplasty was performed over an 8Fr catheter in all patients. With mean followups of 30 months (range 6 to 74) and 38.8 months (16 to 80) the overall complication rates were 60% and 45% for the tubularized incised plate and onlay procedures, respectively. Fistula occurred in 15 patients and repair breakdown in 3 patients (total 51.4%) treated with tubularized incised plate repair, compared to 8 and 2 patients, respectively (25%), treated with onlay repair (p = 0.01). Fistula location also differed significantly between the 2 groups, with proximal fistulas occurring in 11 of 15 tubularized incised plate repairs (73.3%) vs 2 of 8 onlay repairs (25%, p = 0.02). Recurrent ventral curvature was more frequent after onlay urethroplasty (5.7% vs 12.5%, not significant). At a mean age of 5.1 years a plateau uroflow curve (vs normal bell curve) was observed in 16 of 24 children (66.7%) who underwent tubularized incised plate repair and in 7 of 21 (33.3%) who underwent onlay repair (p <0.01). In this series the overall complication rate was similar for tubularized incised plate and onlay urethroplasty. Despite similar urethroplasty calibers, the uroflow curves and fistula positions in patients undergoing tubularized incised plate repair suggest that the neourethra distal to the fistula may be relatively narrow, creating flow resistance and leading to proximal fistula. Longer followup and close monitoring are needed before embracing one approach over the other.

CAN A SLIT‐LIKE MEATUS BE ACHIEVED WITH THE V‐INCISION SUTURED MEATOPLASTY FOR ONLAY ISLAND FLAP HYPOSPADIAS REPAIR?

BJU InternationalVolume 99, Issue 6 p. 1551-1551 CAN A SLIT-LIKE MEATUS BE ACHIEVED WITH THE V-INCISION SUTURED MEATOPLASTY FOR ONLAY ISLAND FLAP HYPOSPADIAS REPAIR? Warren T. Snodgrass, Warren T. Snodgrass Pediatric Urology, University of Texas Southwestern Medical Center and Children’s Medical Center Dallas, Dallas, TX, USASearch for more papers by this author Warren T. Snodgrass, Warren T. Snodgrass Pediatric Urology, University of Texas Southwestern Medical Center and Children’s Medical Center Dallas, Dallas, TX, USASearch for more papers by this author First published: 25 May 2007 https://doi.org/10.1111/j.1464-410X.2007.06970_5.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Volume99, Issue6June 2007Pages 1551-1551 RelatedInformation

357: Comparative Analysis of Tubularized Incised Plate vs. Onlay Island flap Uretrhoplasties for Penoscrotal Hypospadias

You have accessJournal of UrologyModerated Poster 11, Sunday, May 20, 2007 1:00 - 3:00 pm1 Apr 2007357: Comparative Analysis of Tubularized Incised Plate vs. Onlay Island flap Uretrhoplasties for Penoscrotal Hypospadias Luis H. Braga, Joao L. Pippi Salle, Sumit Dave, Sean Skeldon, Armando J. Lorenzo, Walid A. Farhat, Antoine E. Khoury, and Darius J. Bagli Luis H. BragaLuis H. Braga More articles by this author , Joao L. Pippi SalleJoao L. Pippi Salle More articles by this author , Sumit DaveSumit Dave More articles by this author , Sean SkeldonSean Skeldon More articles by this author , Armando J. LorenzoArmando J. Lorenzo More articles by this author , Walid A. FarhatWalid A. Farhat More articles by this author , Antoine E. KhouryAntoine E. Khoury More articles by this author , and Darius J. BagliDarius J. Bagli More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)30610-4AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "357: Comparative Analysis of Tubularized Incised Plate vs. Onlay Island flap Uretrhoplasties for Penoscrotal Hypospadias." The Journal of Urology, 177(4S), p. 119 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 177Issue 4SApril 2007Page: 119 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Luis H. Braga More articles by this author Joao L. Pippi Salle More articles by this author Sumit Dave More articles by this author Sean Skeldon More articles by this author Armando J. Lorenzo More articles by this author Walid A. Farhat More articles by this author Antoine E. Khoury More articles by this author Darius J. Bagli More articles by this author Expand All Advertisement Loading ...

Lengthening the urethral plate with a double flap or a lateral flap technique for repair of primary hypospadias with chordee: 6 year's experience

Purpose Chordee correction in moderate to severe hypospadias usually implies excision of the urethral plate to achieve adequate penile straightening. There has been an evolution of thought about conservation of the healthy urethral plate in hypospadias surgery. We present the first results with a new 1-stage procedure that achieves satisfactory penile straightening and conservation of the urethral plate. Material and methods From December 1999 to October 2006, 23 pediatric patients with primary moderate or severe hypospadias and chordee underwent this 1-stage urethroplasty. The urethral plate is divided into 2 flaps in an oblique fashion (16 patients) or with an only lateral flap (7 patients). We resect the fibrous ventral tissue after mobilization of the plate and we achieve penile straightening. The ventral side of the neo-urethra is harvested from the prepuce with an onlay island flap (18 patients) or penile skin with the Mathieu “flip-flap” procedure (5 patients). Results Mean follow up was 4.2 years (Range 0.6 to 6.8). No intraoperative complications developed during division of the plate and detethering. 8 post operative complications developed (34.7%): Urethrocutaneos fistulae developed in 6 patients, and 2 meatal retractions that required a GAP procedure. No residual curvature or urethral stricture was noted in our series. All 21 patients had excellent cosmetic results. Conclusions We believe that the lengthening of the urethral plate could be a useful procedure in select cases of primary hypospadias with severe chordee. This technique achieves satisfactory penile straightening and excellent cosmetic results, with a similar complications rate to others procedures for this anomaly.

Comparative analysis of tubularized incised plate vs. onlay island flap uretrhoplasties for penoscrotal hypospadias

Purpose To review our experience with penoscrotal hypospadias (PSH), comparing the results of TIP vs. transverse island flap ONLAY urethroplasties. Material and methods A retrospective review of consecutive patients with PSH was performed. 1657 boys underwent hypospadias repair at our institution from 1998 to 2006. 75 comprised our study population: 35 children underwent a TIP repair, and 40 had an ONLAY procedure. Degree of chordee, type of chordee repair, complications, available uroflowmetry in toliet trained-pts., and number of re-operations were compared between the 2 groups. Results Tabled 1 Variables TIP n=35 (%) ONLAY n=40 (%) p Preop severe chordee (> 45o) 7 (20) 18 (45) 0.02 Dorsal plication 19 (54.3) 27 (67.5) Mean catheter duration (days) 8.5 (7-10) 10.3 (7-14) Overall complication 21 (60) 18 (45) NS Fistula/Breakdown 18 (51.4) 10 (25) 0.01 Fistula location (proximal) 13/18 (72.2) 2/10 (20) 0.02 Recurrent chordee 2 (5.7) 5 (12.5) Average flow rate 3.1 to 13.2 3.0 to 16.0 Flattened shape curve 16/24 (66.6) 7/21 (33.3) <0.01 PVR >30% expected blad capac 2/24 (8.3) 0/21 (0) # pts with >2 re-operations 2 (5.7) 7 (17.5) Open table in a new tab Conclusions The overall complication rate was similar for long penoscrotal TIP and ONLAY urethroplasties. The TIP-fistula rate was higher vs. ONLAYS, though catheter duration was the same in both groups. While PVRs were not elevated, more flattened flow curves may suggest that TIP-urethroplasty is narrower and thus, behaves as a relatively “distal resistance” prompting to more proximal fistula formation. Thus, the TIP-fistula rate may benefit from more delayed catheter removal or deeper plate incision. Nevertheless, both techniques appear to be equivalent approaches to correct PSH. Longer follow-up may reveal more divergent outcomes for these 2 approaches. To review our experience with penoscrotal hypospadias (PSH), comparing the results of TIP vs. transverse island flap ONLAY urethroplasties. A retrospective review of consecutive patients with PSH was performed. 1657 boys underwent hypospadias repair at our institution from 1998 to 2006. 75 comprised our study population: 35 children underwent a TIP repair, and 40 had an ONLAY procedure. Degree of chordee, type of chordee repair, complications, available uroflowmetry in toliet trained-pts., and number of re-operations were compared between the 2 groups. The overall complication rate was similar for long penoscrotal TIP and ONLAY urethroplasties. The TIP-fistula rate was higher vs. ONLAYS, though catheter duration was the same in both groups. While PVRs were not elevated, more flattened flow curves may suggest that TIP-urethroplasty is narrower and thus, behaves as a relatively “distal resistance” prompting to more proximal fistula formation. Thus, the TIP-fistula rate may benefit from more delayed catheter removal or deeper plate incision. Nevertheless, both techniques appear to be equivalent approaches to correct PSH. Longer follow-up may reveal more divergent outcomes for these 2 approaches.

Can a slit‐like meatus be achieved with the V‐incision sutured meatoplasty for onlay island flap hypospadias repair?

To evaluate whether the V-incision sutured meatoplasty (VSM) is useful for configuring the constructed meatus after the onlay flap and the Mathieu flip-flap repair for hypospadias, as the transverse preputial onlay island urethroplasty is excellent for repairing anterior hypospadias with no chordee, and a slit-like normal meatus cannot be constructed in many patients who had the original onlay island-flap repair The configuration of the meatus which was repaired by the onlay island flap technique with VSM (group 2) was evaluated and compared with that of the original onlay technique (group 1). Group 1 consisted of 30 patients treated with only the classic onlay procedure as primary hypospadias repair (1999-2001). Group 2 consisted of 22 patients treated using the onlay procedure with VSM as primary hypospadias repair (2002-2004). There were complications after surgery in four (18%) of 22 patients in group 1 and in five (17%) of 30 in group 2, with no significant difference. A slit-like meatus was achieved in eight (27%) of 30 in group 1 and in 12 (55%) of 22 in group 2. There was a significant difference between the groups in meatal configuration (P = 0.04). The VSM is a useful technique to make a slit-like meatus for onlay island flap urethroplasty and flip-flap hypospadias repair, although the technique cannot always achieve the intended result.

The Choice of Surgical Procedures for Hypospadias Repair

目的 探讨不同类型尿道下裂手术方法的疗效.方法 总结388例尿道下裂手术资料,分析不同术式与尿道狭窄及尿道瘘的发生率.结果 尿道口前移、阴茎头成形术(MAGP1)狭窄、尿道瘘发生率为零;Mathieu法的狭窄发生率为9.8%,尿道瘘发生率为5.7%;Denni s-Brown的狭窄、尿道瘘发生率分别为20%和20%;膀胱粘膜法的狭窄和尿道瘘发生率分别为8.6%和1 3%.结论 阴茎头、冠状沟型尿道下裂宜采用MAGPI法,阴茎体型宜采用Mathieu法,近端型宜用加盖岛状皮瓣法或Duplay十Duckett法,膀胱粘膜一期尿道成形术适用于各种类型尿道下裂。

A MULTICENTER EVALUATION OF TECHNICAL PREFERENCES FOR PRIMARY HYPOSPADIAS REPAIR

Considerable controversy exists regarding the optimal surgical technique for the repair of mid shaft and proximal hypospadias. We sought to evaluate differences in surgical preferences among an international cohort of pediatric urologists. An anonymous questionnaire containing relevant demographic data as well as choices of technique to repair 5 representative hypospadias cases was developed and administered. Of 121 pediatric urologists contacted 101 completed the survey, representing an 83% response rate. The majority were full-time academic pediatric urologists who performed 6 to 10 hypospadias surgeries monthly. A total of 92 respondents (confidence interval [CI) 0.84 to 0.96) preferred the tubularized incised urethral plate (TIP) technique for the repair of distal hypospadias. Similarly, 82 (CI 0.72 to 0.88) preferred TIP for the repair of mid shaft hypospadias. The 2 most common techniques for repair of proximal hypospadias without chordee, preferred by 43 correspondents each (CI 0.33 to 0.53), were TIP and transverse island flap (TVIF) onlay. For repair of moderate (30-degree to 40-degree) chordee dorsal plication was preferred by 82 respondents, while a ventral approach was preferred by 12. When moderate chordee was associated TVIF onlay was preferred by 35 (CI 0.26 to 0.45) and TIP by 24 respondents (CI 0.16 to 0.34). For severe chordee (greater than 50 degrees) 31 respondents preferred dorsal plication, while 68 chose some form of ventral repair. Among the respondents 37 approach proximal hypospadias associated with severe chordee using a staged procedure, while 40 use a single stage procedure using a TVIF tube (CI 0.30 to 0.50). Using Spearman's rank correlation coefficient, no significant correlations were identified between respondent practice demographics and choice of repair for each hypothetical hypospadias case. In this cohort of pediatric urologists we observed that the majority prefers TIP to repair distal and mid shaft hypospadiac defects. Significant variability exists for preferred technique for proximal hypospadias and chordee correction. These results support the need for prospective trials comparing techniques for the repair of proximal hypospadias.

An objective assessment of the results of hypospadias surgery

To compare the cosmetic result of tubularized incised-plate urethroplasty (Snodgrass method) with that of two established techniques, the meatal-based flap and onlay island flap repair. Photographs of the penis after hypospadias repair in 32 boys were assessed by a panel of five independent health professionals, including four surgeons with variable paediatric urological experience and a urology nurse. Twenty patients had a distal and 12 a proximal meatus. The Snodgrass technique was applied by one paediatric urologist for either distal (10) or proximal (six) hypospadias. A Mathieu repair was used for distal hypospadias (10) and an onlay preputial island flap for proximal hypospadias (six) by a second paediatric urologist. The panel was asked to grade cosmesis as poor, unsatisfactory, satisfactory or very good (points 1-4) for each of the following aspects of penile appearance: meatus, glans, shaft and overall appearance. Photographs were taken in a standard way, with a standard distance, lighting and two views, one of the dorsal surface and one ventral, for each patient. Signed written consent for the study was obtained from each family. The mean assessment score for any aspect of cosmesis was significantly higher for the Snodgrass technique (P < 0.05). The mean score (95% confidence interval) for the meatus was 0.76 (0.4-1.1) points higher for the patients with a Snodgrass repair than those with a Mathieu or onlay island flap repair (P = 0.002). Correspondingly, the values for the glans were 0.67 (0.38-0.97) (P = 0.003), shaft 0.42 (0.16-0.69) (P = 0.01) and overall appearance 0.62 (0.24-1.0) (P = 0.01) points higher for the Snodgrass repair. The Snodgrass technique was more effective in producing a vertically orientated meatus (87.5%) than the Mathieu and Duckett onlay repairs (37.5%; P = 0.009). The Snodgrass technique, as assessed by this panel, had a better cosmetic outcome than the Mathieu and Duckett onlay island flap repairs. The assessment of cosmesis in hypospadias surgery is potentially more objective when several health professionals, not involved in the surgery, compared the various methods of repair.

Hypospadias reoperations.

To retrospectively evaluate the experience of a single surgeon (YS) with hypospadias reoperations. 105 hypospadias patients were reoperated by the same surgeon between 1994 - 2003. The patients were classified into three groups according to the surgical technique employed. Urethral plate tubularisation was performed in Group I. Repair with genital skin or mucosa was carried out in Group II and repair with extragenital tissues was performed in Group III. Mean age at operation was 6.5 years (range: 1.5 - 23 yrs). Mean number of operations performed was 2 (1 - 7). Group I consisted of 33, Group II of 64, Group III of 8 cases. Reasons for reoperation were complete or partial neourethral loss in 71 cases; big and multiple fistulas in 29; neourethral or meatal stenosis in 11 children. One had diverticula. Two had partial corpus cavernosal loss. Residual or secondary fibrotic ventral flexion was detected in 31/105. Complication rates were 15%, 25% and 0% in Group I, II and III, respectively. Overall complication rate was 20% (21/105). Severe complications can develop not only in proximal but also after distal hypospadias repairs. Local supportive tissues can be provided more easily in proximal reoperations. Repair with buccal mucosa had no complications in our series as it was only used in well selected cases. If urethral plate is present and wide enough, its tubularisation should lead to better results in reoperations. If it is absent or narrow, meatal based or onlay island flaps should be employed. Though the onlay island flap is known to be well vascularised theoretically, our results with meatal based flaps were better. We preferred using the tunica vaginalis when urethral plate was absent and penile skin was not appropriate. We suggest using the onlay technique for large penile defects of the shaft and not in the glanular area. But its use as local supportive tissue in reoperations can be very helpful.

Which procedure should be chosen as a salvage operation in anterior hypospadias cases, meatal-based or onlay island flap? A comparative analysis.

We compared the outcome of flip-flap procedure (Mathieu procedure) with onlay island urethroplasty after previously failed repairs in anterior hypospadias cases. Charts of patients who underwent salvage flip-flap ( n=58) and onlay procedure ( n=24) were reviewed. Age range was 3-19 years (mean: 9+/-4.1) and 2-30 years (10.3+/-5.2) in the onlay and Mathieu groups, respectively ( p>0.05). In the onlay group, the flap was prepared from penile skin and preputial tissue in 5 and 19 cases, respectively. The meatal-based flap was laterally directed in 7 cases in the Mathieu group. The mean number of prior operations was greater in the onlay group when compared with the Mathieu group (1.85+/-1.53 vs. 1.41+/-0.65, respectively) although the difference was not statistically significant (Student's- t test, p>0.05). A total of 14 out of 58 (24.1%) and 6 out of 24 (25%) cases resulted in fistula formation in the Mathieu and island flap groups, respectively. Comparison of the rates of fistula formation did not reach statistical significance (Pearson chi(2), p=0.934). Skin dehiscence in one case and burying of the penis in another patient due to inadequacy of skin for coverage, occurred as complications in the onlay group. Splitting of the glans in 1, dehiscence of skin in 1 patient and complete breakdown of the neourethra in 1 case were the complications encountered in the Mathieu group. Both Mathieu and onlay island procedures have similar success rates as a salvage operation in anterior hypospadias cases if proper patient selection is done. The onlay procedure has been more commonly performed after a failed Mathieu procedure and the reverse rarely occurs.

725 Onlay island flap - A review of one hundred cases - The liverpool experience

725 Onlay island flap - A review of one hundred cases - The liverpool experience

Outcome Analysis of Tunica Vaginalis Flap for the Correction of Recurrent Urethrocutaneous Fistula in Children

Urethrocutaneous fistula is the most common (2% to 10%) complication of hypospadias surgery. The correction of such fistula is associated with a 10% to 40% failure rate. The key measure to ensure a successful repair is separation of the suture lines in the urethra and skin, using well vascularized elastic tissue. If the dartos fascia is unavailable and local penile skin is fibrotic as a result of previous operations, a tunica vaginalis flap may be considered. We report our experience with tunica vaginalis flap as an adjunct to fistula repair. We used tunica vaginalis flap for the repair of recurrent urethrocutaneous fistulas in 14 children with a mean age of 7.6 years (range 3 to 15). All patients had undergone previous hypospadias repairs and previous attempts to close the fistula had failed. The mean number of fistulas per patient was 1.6 (range 1 to 4), and the locations were perineal (1), penoscrotal (3), midshaft (10), and subcoronal (8). The mean number of failed previous closures with local penile skin flaps was 2.4 (range 1 to 5). Surgery was initiated by injecting povidone solution via the urethral meatus to identify all fistulas. Calibration or cystoscopy excluded distal urethral strictures. Surgery was performed using a microscope and fistulas were closed primarily in 12 patients and with an onlay island flap in 2. The urethral suture line was covered with a flap of tunica vaginalis, which was harvested through a small scrotal incision and mobilized via a subcutaneous tunnel into the penis. The testis was then fixed to the scrotum. A urethral stent with or without suprapubic catheter drainage provided urinary diversion for 2 to 7 days. The repair was successful in all patients. During a mean followup of 44 months (range 8 to 60) there was no evidence of recurrent fistulas or urethral strictures. Penile cosmesis was excellent, and all parents reported a straight penis when erected. No postoperative complications were encountered in the testicles. Repair of recurrent urethrocutaneous fistulas with a tunica vaginalis flap is highly effective regardless of fistula location. This flap is easy to mobilize and provides excellent coverage of the urethral suture line. It is a simple procedure with no complications to the testicles.

A strategy for repairing moderately severe hypospadias using onlay urethroplasty versus onlay-tube-onlay urethroplasty

Objectives Moderately severe hypospadias can be repaired by a simple onlay island flap procedure with penile dorsal plication in most patients. However, when the penile curvature could not be corrected, and the urethral plate could not be preserved by the procedure, a combined procedure of onlay and tubularized island flap is subsequently needed. Methods Onlay urethroplasty was performed to repair hypospadias in 39 patients with hypospadias. However, the combined procedure (onlay-tube-onlay urethroplasty) was performed on 6 patients who had severe penile curvature even after skin degloving. Results Hypospadias was repaired successfully without complications in 30 (90.9%) of the 33 patients by conventional onlay urethroplasty alone. Of the 6 patients who underwent onlay-tube-onlay urethroplasty, 1 patient developed fistula and 1 developed meatal stenosis, for a success rate of 66.7%. The complications in all patients were later resolved. Conclusions We recommend switching to onlay-tube-onlay urethroplasty when the attempt to repair moderately severe hypospadias by the simple onlay procedure has to be abandoned, and the urethral plate needs to be divided.

Tissue Expander Enhanced Onlay Island Flap in the Repair of Severe Hypospadias

Tissue Expander Enhanced Onlay Island Flap in the Repair of Severe Hypospadias