Preputial Reconstruction Research Articles

Prepuce‐Sparing hypospadias repair with tubularized incised plate urethroplasty

Modifications in surgical methods of hypospadias repair have been influenced by social considerations. Most Japanese parents wish their children to retain their foreskin during hypospadias repair. We report on short-term results of foreskin reconstruction associated with hypospadias repair. Of 44 tubularized incised plate urethroplasty-patients, 42 (95%) underwent foreskin reconstruction at the time of urethroplasty during the last 2 years. After the urethroplasty was completed, the foreskin was re-approximated in three layers. Complications related to urethroplasty consisted of fistula in two patients with penoscrotal hypospadia, and mild stenosis of the glandular urethra in one patient. Complications related to foreskin reconstruction included dehiscence of the ventral foreskin in two patients. In all cases parents were well satisfied with the reconstructed prepuce. Pre-operative information about preputial reconstruction should be given to parents if they would prefer their son to be uncircumcised.

Preputial reconstruction with distal hypospadias repair

Objective There is growing interest in preputial reconstruction combined with hypospadias repair as an effective technique. We retrospectively analyzed our results and compared them with the literature for future patient information. Materials and methods We evaluated 35 boys during 1 year who underwent distal hypospadias repair combined with preputial reconstruction to determine complications, risks and failures. Results At a mean follow up of 1.2 years, 28 patients had an anatomically normal penis with a normal retractable foreskin, while seven (20%) had some sort of complication. There was a complication of the reconstructed foreskin only in three cases (8.25%), and with the reconstructed urethra in four (10.4%). The most common complications were fistulae of the prepuce and urethra. Only two needed re-operation; the others were managed conservatively. On follow up parents were generally satisfied with the results. Conclusions Preputial repair combined with hypospadias repair lead to anatomically correct reconstruction of the penis at the cost of an 8.25% complication rate. Results were comparable with the standards seen in the literature.

Foreskin Preservation in Penile Surgery

Most hypospadias repairs performed in the United States involve the removal of any foreskin that is not used in the repair, resulting in a circumcised penis. Occasionally, the wishes of the parents or the child are for the final appearance to be that of a normal uncircumcised penis. We report our collective experience from 4 institutions in the reconstruction of the foreskin during penile surgery. A total of 58 patients underwent penile surgery with reconstruction of the foreskin during a 6-year period. Of the patients 49 underwent hypospadias repair, 8 underwent phalloplasty for chordee correction without hypospadias and 1 underwent reconstruction of the foreskin for a dorsal hood without hypospadias or chordee. Of the 49 hypospadias repairs 46 were distal, 2 mid shaft and 1 proximal shaft. The technique for foreskin reconstruction consisted of a multilayered reapproximation of the lateral margins of the dorsal hood after completion of the urethroplasty and glanuloplasty. Among 49 hypospadias repairs 2 patients had dehiscence of the reconstructed foreskin, with development of a urethral fistula in 1. Of the 58 total patients undergoing penile surgery 56 had retractable foreskin, of whom 4 required postoperative steroid application. Three patients/parents requested a secondary circumcision, 2 for an unacceptable cosmetic result and 1 based on personal preference. Foreskin reconstruction in association with penile surgery can be performed safely and with a low complication rate in appropriately selected patients. Cases with a higher risk of complications include those involving more proximal hypospadias and those requiring complete degloving of the penile shaft. Of the reconstructions resulting in phimosis most can be salvaged with the application of steroids.

'Batman excision' of ventral skin in hypospadias repair, clue to aesthetic repair (point of technique).

In the hypospadiac penis the ventral skin is poorly developed, while dorsal skin is redundant. The classical Byars' flaps are a way to use the excess dorsal skin to cover the penile shaft. The appearance after Byars' flaps however is not natural. We use a more natural looking skin allocation with superior aesthetic results. The clue in this reconstruction is an inverted triangle shaped excision of ventral skin expanding over the edges of the hooded prepuce (which makes it look like Batman). After excision of the ventral skin it is possible to close the penile skin in the midline, thus mimicking the natural raphe. In case of preputial reconstruction the excised ventral skin makes the prepuce look more natural. The trend of further refining aesthetic appearance of the hypospadiac penis often neglects the penile skin reconstruction. A technique is presented by which the total penile appearances after surgery ameliorates due to better skin reconstruction.

RESULTS OF PREPUTIAL RECONSTRUCTION IN 77 BOYS WITH DISTAL HYPOSPADIAS

There is growing interest in preputial reconstruction combined with hypospadias repair. We retrospectively analyzed its results for future developments and patient information. We evaluated 77 boys who underwent distal hypospadias repair combined with preputial reconstruction to determine complications, risks and failures. At a mean followup of 2.5 years 52 patients had an anatomically normal penis with a normal retractable foreskin, while 25 (33%) presented with a complication. The most common complications were partial dehiscence, and fistula of the prepuce and urethra. There was a complication of the reconstructed foreskin only in 16 cases (21%), a combined problem with the reconstructed foreskin and reconstructed urethra in 7 (9%), and a problem with the reconstructed urethra in 2 (3%). Of the 25 patients with complications 19 underwent reoperation with closure of the fistula or dehiscence and 5 were circumcised, while in 1 the parents accepted the minor cosmetic problem and refused reoperation. Preputial repair combined with hypospadias repair may lead to anatomically correct reconstruction of the penis at the cost of a 33% complication rate. Parents are informed about this risk and to date in 15% of all boys with distal hypospadias the parents have elected preputial reconstruction.

Improved Mathieu Repair for Coronal and Distal Shaft Hypospadias with Moderate Chordee

A modified Mathieu "flip-flap" technique is described for coronal and distal shaft hypospadias with moderate chordee. The first improvement is the creation of a well vascularised skin flap by leaving the dartos tunica attached to the mobilised skin, thus making it possible to bridge urethral defects up to 2.5 cm. The second improvement is the correction of congenital curvature by partial chordectomy and dorsal plication of the tunica albuginea without the need for circumcision. Preputial reconstruction is possible if required. Twenty patients underwent the procedure with a follow-up of at least 2.5 years; 96 patients had a shorter follow-up. Complications in the group of 20 patients consisted of 1 fistula, 2 meatal stenoses and 1 glanular dehiscence due to severe wound infection. There were no late complications.

GRAP repair: single-stage reconstruction of hypospadias as an out-patient procedure.

A novel repair of the distal urethra with glanular and preputial reconstruction is described for distal penile hypospadias; 52 consecutive patients underwent this procedure without catheter splintage or urinary diversion. All voided without problems on the day of operation; 44 (85%) were treated as day cases, while the remaining 8 boys stayed in hospital for at least 1 night post-operatively for reasons not associated with the operation. Follow-up was complete and ranged from 15 to 30 months (mean 18). There was no evidence of meatal stenosis, phimosis or urethral stricture; 26 boys (50%) had associated chordee pre-operatively which was incompletely corrected in 2 (8%). These have a minor degree of chordee of glans on penile shaft and neither has required further treatment. Four boys (8%) developed partial wound breakdown which necessitated reconstruction in 2 and both of these have now been treated successfully. Functional and cosmetic results are excellent.

Modified meatal advancement and glanduloplasty with complete foreskin reconstruction.

We report 28 boys who underwent repair of a distal hypospadias with a combination of a modified meatal advancement and glanduloplasty and reconstruction of the foreskin. An excellent result was achieved in 24 patients. In 4 boys, preputial reconstruction failed. Only one group of parents demanded further surgery. Improved cosmetic results with avoidance of serious complications make this operation ideal for treating distal hypospadias in countries where the circumcised penis is an exception.

Preputial reconstruction in a dog

Preputial reconstruction in a dog