Transverse Preputial Island Flap Urethroplasty Research Articles

The Effect of Staged Transverse Preputial Island Flap Urethroplasty for Proximal Hypospadias with Severe Chordee

We compare the effects of staged tranverse preputial island flap urethroplasty and the Byars 2-stage procedure in patients with proximal hypospadias and severe chordee. We studied 87 consecutive children referred for proximal hypospadias with severe chordee between March 2011 and March 2014. Of the cases 42 were repaired with staged tranverse preputial island flap (group 1) and 45 were managed by 2-stage Byars urethroplasty (group 2). Mean ± SD age at first stage surgery was 26.6 ± 13.3 months in group 1 and 24.8 ± 14.7 months in group 2. Postoperative complications in both groups were assessed regarding fistulas, urethral strictures, diverticula, meatal stenosis and glanular dehiscence. After the second stage 2 patients (4.8%) in group 1 and 10 (23.2%) in group 2 had urethrocutaneous fistulas (p <0.05). One patient (2.4%) in group 1 and 2 patients (4.4%) in group 2 had urethral strictures (p >0.05). All patients with stricture were cured by repeated dilation and no patient required reoperation. One patient (2.4%) in group 1 and no patient in group 2 had diverticulum (p >0.05). No patient in either group had signs or symptoms of meatal stenosis or residual chordee. Three patients (7.1%) in group 1 and 12 (26.7%) in group 2 needed reoperation (p <0.05). Two-stage urethroplasty, particularly tranverse preputial island flap partial urethroplasty, is appropriate for treating patients with proximal hypospadias and severe chordee. Use of the tranverse preputial island flap can decrease complications associated with the second stage and significantly improve the success rate.

Effects of oral testosterone undecanoate treatment for severe hypospadias.

We sought to evaluate the effects of oral testosterone undecanoate treatment based on the temporary growth of penis and the complications of surgery in children with microphallic hypospadias. A total of 72 randomized consecutive children with microphallic hypospadias were included in the study from March 2011 to September 2013. While 34 children were treated with oral testosterone undecanoate treatment prior to surgery on time (group 1), 36 children did not receive any treatment preoperatively (group 2). All children underwent hypospadias repair using transverse preputial island flap (Duckett technique) urethroplasty or combination of Duckett and Thiersch-Duplay techniques. Penile length, diameter, serum testosterone level, and secondary effects were recorded before and after therapy in group 1. Postoperative complications were assessed with respect to fistulas, urethral strictures, diverticula, meatal stenosis, and glanular dehiscence in both groups. Mean penile length and diameter increased significantly by 1.06 ± 0.53 cm (P < 0.05) and 0.30 ± 0.09 cm (P < 0.05). Postoperative complications included urethrocutaneous fistulas in nine patients (25 %) in group 2 compared to two patients (5.9 %) in group 1 (P < 0.05). While three patients (8.3 %) in group 2 had urethral strictures, no patient in the testosterone group had this complication (P > 0.05). There were three patients (8.3 %) with diverticula in group 2 and three patients (8.9 %) with this complication in group 1 (P > 0.05). None of our patients had signs or symptoms of meatal stenosis, glanular dehiscence, or residual chordee in both groups. Finally, there was a significant difference between the overall reoperation rates of group 2 (14 patients, 38.9 %) and group 1 (five patients, 14.7 %, P < 0.05). Pretreatment with oral testosterone undecanoate was effective in improving the temporary penile growth and decreasing the surgical complications in children with microphallic hypospadias.

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.

Acquired Megalourethra: An Uncommon Complication of the Transverse Preputial Island Flap Urethroplasty

We describe 4 patients with significant dilatation of the entire neourethra following transverse preputial island flap urethroplasty. Two patients presented after repair of chordee without hypospadias, which was corrected by interposition with a pedicle graft. The problem arises about 6 months after the repair and is manifested by ballooning of the urethra during urination and post-void dribbling. We have labeled this entity acquired megalourethra and the repair is similar to that for congenital megalourethra.