Classification of Prepuce in Hypospadias According to Morphological Abnormalities and Their Impact on Hypospadias Repair

Abstract

Morphological characteristics correlated with vascularization of the hypospadiac prepuce. Underdeveloped prepuces and those with unfavorable vascular pattern used for urethroplasty had a higher percentage of complications. In severe hypospadias the anatomical features of the prepuce have greater influence on the proper choice of 1 or 2-stage repair.

The microvessel density of the hypospadiac prepuce in children

“…Using illumination techniques, Perovic and Radojicic [4] found that preputial axial blood vessels were absent in 30% of hypospadiac patients. They also noted that morphological characteristics of the hypospadiac prepuces correlated with their vascularization [5]. Recently, Celayir et al [9] reported the dominant expression of estrogen receptors in penile tissues of children with hypospadias.…”

“…The morphology and vascular anatomy of the prepuce have been previously documented in both normal and hypospadiac subjects [4,5]. However, to the best of our knowledge, the microvessel density of hypospadiac prepuce has never been investigated before.…”

Modified Byars’ flaps for securing skin closure in proximal and mid-penile hypospadias

“…This high complication rate might have been diminished by isolating a smaller island of the dartos flap; or if the dissection were a bit further away from the skin, and both the dartos pedicle and skin would have survived. However, we believe that there are other contributing factors related to the quality of the prepuce which is usually underdeveloped with the more severe degrees of hypospadias [Radojicic and Perovic, 2004]. We thought of changing our technique for skin closure by modifying the old Byars' technique, to allow a multilayered closure without compromising the blood supply to the ventrally placed skin flap.…”

Surgical technique for antegrade dissection of the preputial vascular pedicle during hypospadias repair

“…A single or double faced preputial flap was then raised by dividing the dorsal skin at an appropriate level. The quality of the pedicle vasculature can be assessed by transillumination [11]. The release of the chordee was achieved in the majority of patients following degloving of the penis.…”