Onlay free preputial graft for mid and distal penile hypospadias

Abstract

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.

Comparative Study Between Outcomes of Tubularized Incised Plate Urethroplasty and Modified Tubularized Incised Plate Urethroplasty in the Management of Distal Hypospadias

“…Three of them responded well but meatal stenosis persisted in one patient till last follow-up and was advised for meatoplasty. Above results are compatible with other literatures where meatal stenosis was found 9%, 6.86% in TIP urethroplasty, and 3.3%, no meatal stenosis was found in graft urethroplasty for distal hypospadias [10,12,14,16].…”

“…But no patient in group-B developed urethral stricture, because the raw area had been completely eliminated by immediate grafting in group-B. This finding is comparable with report published in literatures where no stricture was found in graft TIP urethroplasty for distal hypospadias [10,16].…”

“…They performed a modified version of Snodgrass procedure (modified tubularized incised plate urethroplasty) in which a free graft harvested from the inner prepuce was sutured onto the incised plate and claimed better results in terms of complications like meatal stenosis and urethrocutaneous fistula [8]. Kolon and Gonzales also performed a modified version of Snodgrass procedure in which a free graft harvested from the inner prepuce was sutured onto the incised plate and claimed better results in terms of complications like meatal stenosis and urethrocutaneous fistula as it has the added advantage of preservation of the urethral plate without any insult to its vascularity [10].…”

“…Other studies showed that wound dehiscence were observed 2.2%, 1.9% and 3% in Snodgrass procedure in distal hypospadias repair [11][12][13]. But no wound dehiscence was observed in modified tubularized incised plate (TIP) urethroplasty [10,12].…”

The forked flap repair for hypospadias: The reality away from ideality

“…ypospadiology is a field of paediatric urology that is rapidly expanding based on the simple fact that none of the current methods of urethroplasty has been proved superior to the others in terms of achieving the goal of excellent functional and cosmetic results. [1] The ultimate goal of hypospadias surgery is to create a normal looking penis with a terminally situated conical meatus, to correct chordee if present and to ensure a well-directed, straight, and full urinary stream in the standing position. [2] Hypospadias repair is one of the most challenging problems for operating surgeons due to its high complication rate.…”