Comparison of Onlay and Tubularized Island Flaps of Inner Preputial Skin for the Repair of Proximal Hypospadias

Wiener, John S.; Sutherland, Richard W.; Roth, David R.; Gonzales, Edmond T.

doi:10.1097/00005392-199709000-00123

Cited by 34 publications

(48 citation statements)

References 10 publications

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“…In a series of 132 patients, it was concluded that onlay vascularized flaps had fewer complication rates than tubularized vas cularized flaps in terms of fistula and diverticulum for mation. [1] However, the use of tubularized free graft as required in cases of posterior hypospadias has been re ported to be complicated by stricture formation. [2,3,4] Kaplan GW used preputial free graft for neourethral con struction in 21 patients of proximal hypospadias (17 as tubed graft and 4 as onlay graft) and reported few com plications and found his method statistically better than the combined results of other reports (c 2 = 5.38, p<0.05).…”

Section: Discussionmentioning

confidence: 99%

Onlay free preputial graft for mid and distal penile hypospadias

Gangopadhyay

Sharma

Mongha

2005

J Indian Assoc Pediatr Surg

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Onlay free preputial graft for mid and distal penile hypospadias Onlay free preputial graft for mid and distal penile hypospadias Onlay free preputial graft for mid and distal penile hypospadias Onlay free preputial graft for mid and distal penile hypospadias Onlay free preputial graft for mid and distal penile hypospadias ABSTRACT ABSTRACT ABSTRACT ABSTRACT ABSTRACTTubularized free preputial graft for hypospadias repair had been tried in the past and discarded due to high incidence of graft shrinkage causing stricture formation. We have tried to revive the technique using onlay method thus avoiding stricture formation. The technique was used in 33 subjects (Group A) and compared with 33 subjects in control group (Group B) in whom other techniques of urethroplasty were used. The study was a randomized controlled trial. The mean length of the free preputial graft was 22.06 + 4.68 mm (16-35 mm) and breadth was 9.0 + 1.32 mm (7-11 mm). Fistulae developed in 3 patients in group A out of which one healed spontaneously. In group B, 6 patients had fistula formation. Complications developed in 18% cases in group A and 50% cases in group B. There was significant difference between the cosmetic results (p < 0.05) with 58% excellent results in group A and 27% in group B. Free preputial graft onlay urethroplasty has better functional and cosmetic results. KEY WORDS: Hypospadias, Free preputial graft, Onlay urethroplastyHypospadiology is an over expanding field as none of the current methods of urethroplasty have been proved su perior over the others in terms of achieving the goal of excellent functional and cosmetic results. We have de scribed our experience with free inner preputial full thick ness onlay graft urethroplasty in mid and distal penile hypospadias and compared our results with currently used technique.

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Section: Discussionmentioning

confidence: 99%

Onlay free preputial graft for mid and distal penile hypospadias

Gangopadhyay

Sharma

Mongha

2005

J Indian Assoc Pediatr Surg

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“…Several kinds of tissue have been used to correct complex urethral lesions: vein (1), vermiform appendix (2), uterine tube (3), ureter (4), skin (5), bladder mucosa (6), buccal mucosa (7), dura mater (8), peritoneum (9), tunica vaginalis (10), and preputial island flap (11). The best results have been achieved with preputial island flaps in onestage surgeries for the construction of neourethras (12,13).…”

Section: Introductionmentioning

confidence: 99%

Urethroplasty using a bovine pericardium graft: an experimental study using normal urethras from dogs

Lara

Lucon

Arap

2004

Braz J Med Biol Res

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The use of bovine pericardium as a urethral patch to substitute a ventral segment of canine urethras was studied. Healing, epithelial growth, urethral permeability, fistulas, and calcification were analyzed. Thirty male mongrel dogs of medium and large size underwent resection of a ventral segment of the medial urethra measuring 2.0 x 0.5 cm, which was replaced with a bovine pericardium graft, treated with buffered glutaraldehyde and preserved in formaldehyde. Two running sutures of polygalactin 5-0 were applied, one on each side of the patch. The corpus spongiosum was closed with uninterrupted suture and the skin with interrupted suture of polygalactin 5-0. Six months later, the animals were examined and sacrificed under anesthesia. Retrograde urethrograms showed that the urethral healing was complete in six of the 30 animals, without stenosis, fistulas or dilations. Microscopic examination showed complete epithelization of these six urethras. The remaining 24 animals presented urethrocutaneous fistulas without stenosis, demonstrated by urethral catheterism using a 10-Fr plastic catheter. These data show that a successful urethral reconstruction of the penile urethra was possible in only 20% of the operated animals. Infection and leakage may be the cause of the urethrocutaneous fistulas present in 80% of cases. Further studies are necessary to determine whether such fistulas are avoidable. If they are, the bovine pericardium may well be an option in the treatment of urethral lesions in dogs.

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“…Nevertheless, Borer et al [5] reported proximal TIP repair in 25 patients with complications in three (12%), while the series by Chen et al [4] included 40 boys, with complications occurring in seven (18%). In addition, alternative repairs in common use for proximal hypospadias, including onlay and tubularized preputial grafts, have similar or higher complication rates than in the present series [12,14], and are arguably less reliable than TIP for creating a cosmetically normal meatus. Finally, based on our experience we no longer use TIP urethroplasty if the incised plate resembles those shown in Fig.…”

Section: Discussionmentioning

confidence: 59%

“…The ®rst is that the plate is usually not the cause of ventral curvature, and so resection of these tissues often does not correct bending [10]. The second is that incorporation of the plate into the urethral reconstruction may reduce complications [11,12]. Although most of the present patients had curvature on arti®cial erection, in most the degree of bending was mild and readily straightened by dorsal plication with no appreciable shortening of the penis.…”

Section: Discussionmentioning

confidence: 81%

Tubularized incised-plate urethroplasty for proximal hypospadias

Snodgrass¹,

Lorenzo²

2002

BJU Int

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Objective To report the experience of one surgeon using tubularized incised-plate (TIP) urethroplasty to repair proximal hypospadias in a consecutive series of boys. Patients and methods The records of 33 consecutive patients with midshaft to scrotal hypospadias undergoing TIP repair by one surgeon were reviewed. Dorsal plication was used as necessary for penile straightening, to preserve the urethral plate. Standard TIP urethroplasty was undertaken, and the follow-up included the selective use of neourethral calibration and urethroscopy. Results Plication was necessary in 18 (55%) patients.The incised plate had a supple appearance in all but two boys. The mean (range) follow-up was 9 (1±48) months and included calibration in 16 (48%) and urethroscopy in 13 (39%) patients. Complications were noted in 11 (33%) boys, of whom seven (21%) developed small ®stulae. The two patients in whom the incised plate appeared unhealthy had dehiscence of the repair and contracture of the neourethra with recurrent penile curvature, respectively. There was one meatal stenosis and one short neourethral stricture. Conclusions TIP urethroplasty can be used to repair proximal hypospadias in the absence of severe penile curvature, and if the incised urethral plate has a supple appearance. As with distal hypospadias repair, the procedure creates a normal-appearing penis with a slit-like meatus.

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Comparison of Onlay and Tubularized Island Flaps of Inner Preputial Skin for the Repair of Proximal Hypospadias

Abstract: Hypospadias repair using transverse island flaps offers reliable and durable outcomes. While overall complication rates were not greatly different between tubularized and onlay flap repairs, onlay repair tended to result in fistulas of smaller size and diverticula did not develop.

Cited by 34 publications

References 10 publications

Onlay free preputial graft for mid and distal penile hypospadias

Onlay free preputial graft for mid and distal penile hypospadias

Urethroplasty using a bovine pericardium graft: an experimental study using normal urethras from dogs

Tubularized incised-plate urethroplasty for proximal hypospadias

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