Preputial Reconstruction Research Articles

Primary preputial reconstruction following surgical excision of cutaneous mast cell tumours without penile amputation in eight dogs

ABSTRACT Case history: Medical records from a single referral hospital (Davies Veterinary Specialists, Hitchin, UK) were reviewed to identify dogs (n = 8) with preputial cutaneous mast cell tumours (CMCT) that underwent surgical excision and primary preputial reconstruction, preserving the penis and urethra, after clients declined alternatives such as penile amputation and urethrostomy, from June 2017–June 2022. Clinical findings: Tumours had a median diameter of 21.5 (min 15, max 30) mm, were located cranioventrally (3/8), caudoventrally (1/8), laterally (2/8) and dorsally (2/8) relative to the prepuce and were diagnosed as CMCT based on cytology. No dogs had hepatic or splenic metastasis on cytology but inguinal lymph node metastasis was identified in 3/4 dogs sampled. Treatment and outcome: The owners of all dogs had declined penile amputation and scrotal urethrostomy. The CMCT were excised and primary reconstruction of the prepuce performed. Surgical lateral margins of 10, 20 or 30 mm were used and the deep margin excised the inner preputial lamina or underlying muscular fascia. The deep margin for caudoventral CMCT involved excision of the underlying SC adipose tissue. Preputial advancement was performed in 3/8 dogs to achieve adequate penile coverage. Histopathology confirmed all CMCT were Kiupel low grade, Patnaik grade II with complete margins in 6/8 dogs but identified metastasis only in one inguinal lymph node from one dog. Two dogs encountered minor complications (infection and a minor dehiscence) and one dog had a major complication (infection with major dehiscence). Median follow-up duration was 125 weeks, excluding one dog with 4 weeks of follow-up. None of the dogs experienced local recurrence or died of mast cell disease during the available follow-up period. Clinical relevance: This clinical study evaluated a surgical alternative to penile amputation and advanced reconstructive techniques for Kuipel low/Patnaik grade II preputial CMCT when these procedures were declined by owners. Surgical excision of preputial CMCT with lateral margins of 10, 20 or 30 mm with primary preputial reconstruction is achievable with low morbidity and a good outcome when penile amputation and scrotal urethrostomy is not an option.

Glans Anthropometry for Preputial Reconstruction in Hypospadias.

Cases of hypospadias present for poor stream or cosmetic appearance. The main aim is to provide a visibly normal phallus. Preputial reconstruction is technical. A properly planned reconstruction based on anthropometry may improve the result. We are presenting our experience of reconstruction based on glans anthropometry. The aim of the study was to evaluate the importance of glans anthropometry in preputial reconstruction in cases of hypospadias. All cases of hypospadias operated between June 2014 and March 2022 were included. Glans width was measured at the base. The marking sutures for preputial reconstruction were taken at distance thrice the glans width at base. Those requiring religious circumcision along with repair, associated significant chordee, catheter came out before 2 weeks, or history of any previous penile surgery were excluded. All the cases were subjected to urethroplasty, meatoplasty, and preputioplasty. The results obtained were analyzed. One hundred and forty-eight out of 159 cases formed the study group. There were 31 glanular, 42 distal penile, 58 mid-penile, and 17 proximal penile hypospadias. Mean glans width at base was 16 mm (range: 11-21 mm). Mean distance of marking suture at prepuce was 38 mm (range: 33-63 mm). Mean follow-up was 12 months (range: 1-36 months). Mean age at presentation was 23 months (range: 14-72 months). Mean operating time was 50 min (range: 45-60 min). Fistula at the base of preputioplasty was seen in four. Dehiscence of preputioplasty was seen in six. Meatal stenosis was seen in three cases. Preputial reconstruction improves the cosmetic appearance of the hypospadiac penis. Reconstruction based on glans anthropometry improves the result and avoids complications.

Self-reported outcomes after the onset of puberty in patients undergoing primary distal hypospadias repair by the tubularized incised plate technique combined with preputial reconstruction vs. circumcision: A norm related study

PurposeWe assessed self-reported outcomes after the onset of puberty in patients undergoing tubularized incised plate (TIP) repair in combination with preputial reconstruction (PR) or circumcision for primary distal hypospadias, in comparison to normal controls. Material and methodsOut of 498 patients undergoing primary distal hypospadias repairs between 2001 and 2012, 83 underwent TIP repair associated with PR or circumcision before age 10-year, and had a Tanner stage ≥2 at study. Outcomes were assessed by online self-administration of validated questionnaires and additional non-validated questions. Results were compared between patients undergoing TIP repair vs. normal age-matched controls (healthy volunteers), and, between patients undergoing PR vs. circumcision. ResultsForty-one of the 83 eligible patients completed the study (response rate 49.3%). Of these, 26 had undergone PR. Median post-operative follow-up was 11.8 (range 6.5–16.2) years. The control group included 45 healthy boys. Comparing groups, there were no statistically significant differences in the cosmetic aspect of the penis, patient perception of penile appearance, and quality of life. Irrespective of preputial management, patients reported fear of being teased for the appearance of their genitalia much more commonly than controls (p = 0.02), but this did not affect their relationship patterns and quality of life. ConclusionSelf-reported outcomes after the onset of puberty were not significantly different between patients undergoing primary TIP repair of distal hypospadias in childhood and normal controls. Patients were significantly more commonly feared of being teased for their genital appearance, but this did not interfere with their social skills. Preputial management, namely PR vs. circumcision, did not affect the outcome.

A prospective study comparing modified foreskin reconstruction versus circumcision with tubularized incised plate urethroplasty for distal and mid penile hypospadias

In Asian countries and the Hispanic populations, parents of many hypospadias patient demands prepuce to be saved. Foreskin reconstruction is a technique for achieving the nearly natural appearance of hypospadias penis. In most distal and selected mid-penile hypospadias it may be performed. Numerous specialists, however, support circumcision for the concern that foreskin reconstruction may endanger the repair of urethroplasty leading to the risk of formation of fistulas. To evaluate the surgical complications and outcome of modified foreskin reconstruction (MFR) versus circumcision with tubularized incised plate urethroplasty for distal and mid penile hypospadias. This prospective comparative study included 80 children with distal and mid penile hypospadias treated from 2017 to 2019 in tertiary referral hospital. Group 1, n=40 underwent TIPU and MFR, and Group 2 included 40 patients for TIPU with circumcision. In group 1, patients ranged from 2.2 to 6.5 years (mean 4.6±1.52 years) and in group 2 ranged 2.6-7 years (mean 4.59±1.43 years). Specific to group 1 preputial edema was seen in 29 patients at 2nd weeks, completely disappeared by 8thweek. Retraction of prepuce was possible in 18 patients by 21 days and all but one by 6 months Foreskin wound gaping was seen in 1at day 12 postoperatively and was repaired subsequently. Meatal stenosis was seen in one in both group, responded to urethral dilation by 6 weeks. Three patients from group 1 and 2 from group 2 developed urethral fistula which was subsequently closed. The complication rate was not statistically significant. Secondary phimosis was not seen in this study. A wide preputial opening was achieved during reconstruction in all patients in group 1. One of the notable features, the absence of the prepuce, makes the patient conscious of the surgical procedure they had undergone. The specific complication of the preputial reconstruction is the presence of a non-retractile prepuce at the end of the surgery, secondary phimosis, preputial wound gaping, and dehiscence. In some patients, the distal portion of the prepuce becomes narrow, after vertical reconstruction. To prevent phimosis, the technique was improvised by taking transverse sutures in the distal part combined with midline approximation of the foreskin. This widens the preputial ring enabling smooth retraction of the reconstructed prepuce. TIPU with MFR is an effective procedure for distal and selected mid penile hypospadias without increasing urethroplasty complications.

Outcomes of preputioplasty in patients undergoing TIP urethroplasty (tubularization of incised urethral plate) for distal and mid penile hypospadias

Preputioplasty as a part of hypospadias repair restores the normal appearance of phallus, which is especially important in distal and mid penile hypospadias. However possibility of its inherent complications such as iatrogenic phimosis or preputial breakdown are the cause of controversy and reluctance regarding this procedure.This study evaluates the results of preputial reconstruction with TIP urethroplasty in distal and mid penile hypospadias repair and analyses if preputioplasty may be offered to these patients. In this prospective observational study, 48 cases of distal and mid penile hypospadias underwent TIP urethroplasty and preputioplasty and results were assessed at 2 weeks, 3 months and 6 months. Major complications included preputial dehiscence, tight prepuce (iatrogenic phimosis) and minor complications included ventral tethering, persistent dorsal whorls and redundant prepuce. Data was analysed with Microsoft Excel spreadsheet where descriptive statistics were obtained. Preputioplasty was performed in 48 children with a mean age of 5.1 years. Preputioplasty dehiscence was seen in three (6%) patients, which gave an appearance of irregular prepuce on 6m follow up. Two patients (4%) were confirmed to have preputial tightness at 3 months but this resolved conservatively in one patient and only one patient (2%) required circumcision for a tight prepuce. Minor complications included ventral tethering, persistence of dorsal whorls and redundant prepuce. Ventral tethering was present in 3 patients (6.25%). Redundant prepuce was observed in 2 patients (4.16%). Additionally, unsightly dorsal whorls were found to be persistent in 2 children (4.16%). None of these patients opted for circumcision. The rest of the children had a cosmetically and functionally normal prepuce. Two patients (4%) developed urethrocutaneous fistula at 3 months' follow-up. Preputial reconstruction is feasible with a good cosmetic outcome and minimal complications in patients of distal and mid penile hypospadias undergoing TIP urethroplasty. Mild preputial tightness evolves over time and resolves with conservative measures. In patients with very prominent dorsal whorls and underlying bulky tissues the preputioplasty does not appear to be of satisfactory cosmesis. To help the patient and parents take a well informed decision, it would be useful to explain all possible major and minor foreskin complications, and their rectification.

A proposed technique for one-step preputial reconstruction in the dog.

To describe a reverse axial pattern flap based on the superficial branch of the dorsal penile artery and describe its use in preputial reconstruction. Ten penises were harvested from canine cadavers; five were used to describe the dermatome supplied by the superficial branch of the dorsal artery of the penis and five to show perfusion of the skin flap. The superficial branch of the dorsal artery of the penis was identified fluoroscopically by injecting contrast material into the dorsal artery of the penis. This artery was then catheterised and injected with methylene blue to identify the perfused area. A skin flap was created by making a full thickness skin incision at the level of the fornix, along the circumference of the penis. The flap was developed by pulling the cut end toward the tip of the penis while undermining the skin. The flap was considered long enough when the cut end of the flap reached the level of the urethral opening. We also describe a case of preputial resection and reconstruction using this flap. Injection of methylene blue demonstrated the arterial supply to the skin flap. This flap was successful in treating the clinical case following resection of a mast cell tumour on the prepuce, although a small area of full thickness flap necrosis, which healed by second intention, developed postoperatively. This technique may be useful for single step preputial reconstruction.

Distal hypospadias repair using the needle point bipolar cutting–coagulation forceps

To determine the outcome of distal hypospadias repairs performed using bipolar diathermy (BD) for all the dissection. Retrospective review of 310 patients undergoing distal hypospadias (264 subcoronal/distal penile and 46 coronal/glanular) over a 11-year period. Median age at surgery was 2.0 years (range 9 months-15 years). Caudal anesthesia was performed in all patients. All children underwent an in situ tubularization of the urethral plate, which was combined with midline incision of the plate in 30 (10%). Preputial reconstruction was performed in 303 (98%) patients. BD forceps was used for coagulation and for all the dissection including skin incision, elevation of glans wings, separation of the corpus spongiosum from the corpora cavernosa, and urethral plate incision, when deemed appropriate. The authors assessed surgical complications and cosmetic results. The latter using the hypospadias objective score (HOSE), with a score≥14 considered as acceptable. The average operative time was 70min. There was no postoperative bleeding or hematomas that required surgical intervention. There were no wound infections or necrosis. Complications occurred in 37 patients (11.9%). Urethral fistula formation was the commonest (n=18). Postoperative persistent preputial swelling occurred in 3.5% of cases. Two hundred twelve patients (90.6%) had a HOSE score≥14, and no patient required revision surgery for skin problems after a median follow-up of 8.1 (range 1.2-13.1) years. The study is limited by its retrospective nature and by the fact that a number of other pre-operative, intra-operative, and postoperative variables can affect outcome. Bipolar diathermy can be safely used for distal hypospadias repairs. It allowed careful control of intra-operative bleeding and also clear visualization of tissue planes. Complication rate overall compares favorably with the literature, and cosmetic results were satisfactory.

Combined caudal-superficial-epigastric axial pattern flap and full-thickness buccal mucosa graft for single-stage preputial reconstruction in six dogs.

To describe the use of a caudal superficial epigastric flap in combination with a full-thickness oral mucosal/submucosal graft for single-stage reconstruction of extensive preputial defects in dogs. Medical records of dogs with extensive preputial defects either of traumatic origin or derived from tumour excision were reviewed. In all dogs, the prepuce was reconstructed using a full-thickness oral mucosal/submucosal graft combined with a caudal superficial epigastric axial pattern flap during a single surgical procedure. Outcome was assessed by routine clinical examinations for 6months postoperatively, and through telephone follow-up thereafter. Six dogs were included. The caudal superficial epigastric axial pattern flap healed without complications in all dogs, while the full-thickness oral mucosal/submucosal graft failed in one dog. In this individual the skin flap underwent contracture 30 days after surgery and preputial advancement was required. One dog showed postoperative discomfort during urination, which was successfully managed with a Foley catheter and analgesic administration. Three dogs developed paraphimosis at 30, 80 and 90 days, respectively, and required further surgery. Long-term results were good in all dogs. The use of a full-thickness oral mucosal/submucosal graft combined with a caudal superficial epigastric axial pattern flap is feasible for single-stage preputial reconstruction in dogs. Attention should be paid to create a sufficiently large preputial opening, in order to prevent paraphimosis.

Preputial reconstruction and urethrostomy after subtotal penile amputation in a dog

A 7-year-old, 4.2-kg intact male toy poodle was presented to the referring veterinarian with a persistent penile erection and secondary paraphimosis. A full-thickness longitudinal incision was made in the prepuce to release strangulation by the preputial orifice. Castration was also performed. However, the persistent erection did not resolve, which suggested idiopathic priapism. Although prescrotal or scrotal urethrostomy was considered, these procedures commonly have complications, such as severe hemorrhage, stricture of the urethral opening, urine scalding, and abnormal cosmetic appearance. Therefore, preputial reconstruction and urethrostomy were performed following amputation of the penis. A V-Y skin plasty was performed to retract the prepuce caudally. Two triangles of preputial skin at the middle of the prepuce were removed to shorten the prepuce. A 6-Fr catheter was kept in place for 9 days after surgery to prevent stricture formation and to divert urine during initial healing. After surgery, the dog was able to urinate through the natural preputial orifice, showing no urine scalding of the urethrostomy site. Six months after surgery, nomajor complications were observed. The owner was satisfied with the functional and cosmetic outcome.

Preputial reconstruction in hypospadias repair

In principle, the prepuce can be reconstructed during hypospadias repair, but the procedure has not gained wide acceptance and preputial reconstruction (PR) is surrounded by several controversies. A review is provided of the technique for PR, how PR combines with the other steps of hypospadias repair, the risks of complications related to the urethroplasty and specific to PR, and the results of PR with particular regard to the relevance for the patient and his family. PR can be important for patients requiring hypospadias repair and their parents. It can be performed in almost all patients with distal hypospadias except perhaps those with the most asymmetrical prepuces or severe ventral skin deficiency. PR does not seem to increase urethroplasty complications, but combination of PR with tubularisation of the urethral plate urethroplasty seems to offer the best chance of success. Specific complications occur in around 8% of patients and include partial or complete dehiscence of the prepuce and secondary phimosis. To prevent the latter, the reconstructed prepuce should be easily retractile at the end of surgery. Technical modifications can help to achieve this goal. Cosmetically, reconstructed prepuces are not fully normal, but the abnormality could be less important for a patient and his parents that the complete absence of the prepuce. On the basis of the evidence summarised above, an algorithm for PR in patients with distal hypospadias is proposed. PR can be offered to the vast majority of distal hypospadias patients, although some modification of the technique for hypospadias repair can be required. Retractility of the reconstructed prepuce at the end of surgery seems paramount for final success.

Does Preputial Reconstruction Increase Complication Rate of Hypospadias Repair? 20-Year Systematic Review and Meta-Analysis.

We performed a systematic review of the literature on preputial reconstruction (PR) during hypospadias repair to determine the cumulative risk of preputial skin complications and the influence of PR on urethroplasty complications, namely, fistula formation and overall reoperation rate of the repair. A systematic search of the literature published after 06/1995 was performed in 06/2015 using the keyword "hypospadias." Only studies on the outcome of PR in children, defined as dehiscence of the reconstructed prepuce or secondary phimosis needing circumcision, were selected. A meta-analysis of studies comparing PR vs. circumcision was performed for the outcomes "hypospadias fistula formation" and "reoperation rate." Twenty studies were identified. Nineteen reported the outcome of PR in 2115 patients. Overall, 95% (2016/2115) of patients undergoing PR had distal hypospadias. The cumulative rate of PR complications was 7.7% (163/2115 patients), including 5.7% (121/2115 patients) preputial dehiscences and 1.5% (35/2117 reported patients) secondary phimoses needing circumcision. A meta-analysis of seven studies comparing patients undergoing PR vs. circumcision showed no increased risk of urethral fistula formation associated with PR, odds ratio (OR) (Mantel-Haenszel, Fixed effect, 95% CI), 1.25 (0.80-1.97). Likewise, two studies comparing the overall reoperation rate did not show an increased risk of reoperation associated with PR, OR (Mantel-Haenszel, Random effect, 95% CI), 1.27 (0.45-3.58). PR carries an 8% risk of specific complications (dehiscence of reconstructed prepuce or secondary phimosis needing circumcision), but does not seem to increase the risk of urethroplasty complications, and the overall reoperation rate of hypospadias repair.

Preputial reconstruction after traumatic avulsion in a dog

La perdida amplia del tejido prepucial puede predisponer a lesiones e infecciones del pene y por tanto debe ser tratada con prontitud. Lesiones extensas pueden requerir tecnicas reconstructivas y amputacion parcial o incluso total del pene. Este reporte describe el caso de un perro mestizo que sufrio una lesion por avulsion traumatica en la region inguinal, prepucial y en los miembros pelvicos. El tratamiento quirurgico fue realizado utilizando un colgajo cutaneo de patron axial obtenido de la extremidad amputada debido a las severas lesiones que esta presentaba, para realizar la reconstruccion de la region inguinal y del prepucio. La evolucion del area afectada fue exitosa, sin la necesidad de realizar una amputacion peneana.

Surgical narrowing of the preputial orifice for treatment of recurrent penile prolapse in a degu (Octodon degus)

Paraphimosis and penile prolapse have been described in hystricomorph rodents. Commonly the cause is a ring of fur or debris, found at the base of the penis, especially in chinchillas....

Isolated preputial reconstruction in distal hypospadias

ObjectiveThe aim of this single centre study was to determine: a) the outcome of isolated preputial reconstruction in distal hypospadias and b) overall parental satisfaction. MethodsA retrospective analysis of case notes was performed to determine outcome. Postal parent-satisfaction questionnaires were devised to quantify subjective assessment of care and outcome. ResultsA total of 33 cases of isolated preputial reconstruction were identified between 2006 and 2012. Three sets of notes were untraceable. The median age of the 30 remaining patients at surgery was 23 months (range 11–119). At follow-up, 28 (94%) patients had retractile foreskins that had healed well. One patient (3%) had a foreskin fistula and the parents chose to proceed with circumcision rather than fistula closure. A second patient (3%) developed late phimosis secondary to balanitis xerotica obliterans and also underwent circumcision. Twelve follow-up questionnaires were returned. The median overall success rating of the operation was 4.7/5.0 (94%). All respondents reported that they would recommend the procedure to another parent whose child has a similar diagnosis. ConclusionIsolated preputial reconstruction improves the cosmetic appearances in distal hypospadias, has a low complication rate and offers high parental satisfaction.

Commentary to ‘Foreskin retractility following hypospadias repair with preputioplasty – Medium term outcomes’

The prepuce is erogenous tissue and, in hypospadias patients, can be precious in case of failure of the primary repair, whereas the putative medical benefits of circumcision have been broadly questioned. Therefore, unless circumcision is desired for cultural reasons, preputial reconstruction (PR) might be considered sensible during primary hypospadias repair, whenever feasible. Foreskin retractility following hypospadias repair with preputioplasty – Medium term outcomesJournal of Pediatric UrologyVol. 9Issue 6PreviewTo assess the medium term outcome of hypospadias repair and preputioplasty with regard to foreskin retractility, and whether this could be predicted by assessing retractility at the end of the operation. Full-Text PDF

Mathieu repair of distal and midshaft hypospadias: risks and benefits of foreskin reconstruction versus circumcision.

BackgroundThe purpose of this study was to compare the risks and benefits of Mathieu repair of hypospadias with or without circumcision in consecutive operated cases.MethodsEighty-six children with midshaft or distal hypospadias were randomly divided into two groups and underwent circumcision (Group A) or preputial reconstruction (Group B) during hypospadias repair. Postoperative complications, outcomes, and parental satisfaction were assessed for circumcised and uncircumcised patients. All patients with midshaft or distal hypospadias with or without minimal chordee were included.ResultsNo statistically significant differences in urethral complications were found between the two groups. Meatal stenosis occurred in one case in Group A and one case in Group B. Fistulae occurred in five cases in Group A and six cases in Group B. Urethral dehiscence occurred in no case in either group. No case of phimosis was seen in Group B. After a mean follow-up of 6 months, all parents of Group A cases stated that they were satisfied with the circumcision for religious and/or social reasons, but no parents of Group B cases were satisfied with preputioplasty (P ≤ 0.05). No case of hypospadias repair failure was seen in our operated cases. Finally, no cases in Group B required redo hypospadias surgery.ConclusionMathieu repair with synchronous circumcision is feasible in all patients with distal or midshaft hypospadias with or without minimal chordee, and should be considered in accordance with surgeon preference. In the case of prepuce preservation, parents should be informed that there is a benefit of tissue banking for probable redo hypospadias repair but with an increased risk of complications and a need for another procedure, ie, circumcision.

Foreskin reconstruction and preservation of a thin distal urethra: a challenge in tubularized incised plate urethroplasty

The aim of this retrospective study was to evaluate the functional and cosmetic outcome of tubularized incised plate urethroplasty (TIPU) with preputial reconstruction and preservation of a thin distal urethra when applicable. The records of 64 boys with hypospadias, who underwent TIPU between 2000 and 2007 were analyzed. 33 (52%) underwent foreskin reconstruction and a thin distal urethra was preserved and incorporated in 19 (30%) patients. The Hypospadias Objective Scoring Evaluation (HOSE), Pediatric Penile Perception Score (PPPS), and uroflowmetry were evaluated in 55 boys (86%) after a mean of 4.8 years. All patients had a vertically oriented meatus. The overall rate of fistula occurrence was 9% and of wound dehiscence, 5%. Among 33 preputial reconstructions, two (6%) patients had dehiscence and three (9%) had a fistula. No cases of stricture or stenosis occurred. There were significantly more complications with reconstruction of the foreskin (p = 0.012) and preservation of a thin distal urethra (p = 0.021). Uroflowmetry was normal in 76% of patients. PPPS and HOSE revealed excellent results. TIPU produces excellent cosmetic and functional results with few complications; complications are more common after foreskin reconstruction and use of a thin distal urethra.

Preputial reconstruction and tubularized incised plate urethroplasty in proximal hypospadias with ventral penile curvature

Aims:Objective of this study was to assess the feasibility and results of preputial reconstruction and tubularized incised plate urethroplasty (TIP) in patients of proximal hypospadias with ventral penile curvature.Materials and Methods:Twenty-seven patients of proximal hypospadias who underwent preputioplasty with TIP were evaluated retrospectively. Ventral curvature was corrected by mobilization of the urethral plate with the corpus spongiosum and the proximal urethra; dorsal plication was added according to the severity of curvature. Feasibility of preputial reconstruction was assessed by applying 3 stay sutures—the first to fix the skin at the corona, the second at the junction of the inner and outer preputial skin for pulling up the skin over the glans, and the third stay on penile skin at the level of the corona for retracting the skin. Preputial reconstruction consisted of a standard 3 layered re-approximation of the margins of the dorsal hood.Results:Age of the patients varied from 10 months to 21 years with an average of 6 years and 4 months. Ventral curvature (mild 10, moderate 13, and severe 4 cases) was corrected by the mobilization of the urethral plate and spongiosum in 14 patients, 11 cases had mobilization of the proximal urethra in addition and 2 patients required single stitch dorsal plication with the above-mentioned steps. Two patients developed urethral fistula and 1 had preputial dehiscence.Conclusions:Preputioplasty with TIP is feasible in proximal hypospadias with curvature without increasing the complication rate. Postoperative phimosis can be prevented by on-table testing of the adequacy of preputial skin by 3 stay sutures.

Long-Term Results of Preputial Reconstruction in Selected Cases of Hypospadias

Purpose To evaluate the long-term results of preputial reconstruction (PR) (instead of circumcision) in selected cases of hypospadias repairs. Material and Methods 216 consecutive primary hypospadias repairs performed before 01/01/2000 by 2 pediatric urologists in 1 institution were identified; 9 were lost for FU, the remainder had a mean FU of 93 (minimum: 60) months. PR was performed in all cases where this was both technically feasible and the parent's preference. Types of hypospadias repair were MAGPI in 98, Mathieu in 32, TIP in 26, onlay in 49 and 2-stage in 2 cases. PR was performed in 128 of 207 cases (62%); This was after MAGPI, Mathieu, TIP, Onlay and 2-stage type repairs in 85(87%), 21(66%), 20(77%), 2(4%) and 0(0%) repectively. Results Three specific types of complications can occur after PR which are avoided by primary circumcision: dehiscence of the PR, formation of a preputial fistula ( = minor partial dehiscence, not communicating with the urethra) or syptomatic / fibrotic phimosis. In this series, 16 boys (8%) had a specific PR-related complication leading to re-operation in 11(5%): 8 preputial fistulae (1 circumcision; 5 fistula-repairs; 2 no intervention) and 8 symptomatic and/or fibrotic phimosis (3 circumcisions; 2 preputioplasties; 3 conservative management). No preputial dehiscence occurred. No significant differences in PR-related complications were seen after different types of hypospadias repairs. The majority of PR-related complications occured during the first year after hypospadias repair. In the remaining 112 boys, the prepuce was fully retractible in 110 and partially retractible in 2 (without fibrosis or symptoms) at the last FU visit. Our results are comparable to the very scarce previous literature on this subject which has upuntill now only presented short-term results. Conclusions Preputial reconstruction is feasible in over 60% of hypospadias repairs (if this is the patient's/parent's preference) at the cost of a limited number of additional complications (8%) and re-operation rate (5%).

A New Suture Material for Hypospadias Surgery: A Comparative Study

We compared the results of hypospadias repair using polyglytone versus polydioxanone to evaluate the potential benefit of using a suture with a rapid absorption time. A total of 100 patients 8 to 24 months old affected by distal isolated penile hypospadias were considered for this study. Patients were randomized and assigned to 2 different groups according to the suture material used during the surgical procedure (tubularized incised plate repair with or without preputial reconstruction). Polyglytone was used in group A and polydioxanone was used in group B. All patients were evaluated at 4 intervals (1 week, 1 month, 6 months and 2 years postoperatively). Persistence of sutures on penile skin, urethral fistulas, skin dehiscence, infection and skin tracks were recorded. Statistical analysis was performed using chi-square test. Followup data documented the absence of significant differences in terms of urethral fistula rate, skin dehiscence and acute skin infection. Persistence of sutures and multiple skin tracks at long-term followup were significantly greater in patients in group B. Both sutures are adequate for hypospadias surgery in small children. The use of a rapid absorption monofilament may allow much more rapid disappearance of the skin sutures. In the long term this outcome means almost complete absence of suture tracks. No statistically significant difference in terms of urethrocutaneous fistula was observed, suggesting that the tensile strength of polyglytone is adequate.