Pedicled preputial island flap for double functions in hypospadias surgery

Abstract

Objective: To use the prepuce for double functions one as a second layer for the neourethra to decrease the incidence of urethrocutaneous fistula and the second as a skin covering for the ventral aspect of the penis. Material and methods:From January 2013 to December 2016, 37 cases of hypospadias with mild to moderate chordee were included in this study. The cases with ventral penile skin defect were managed by tubularized incised plate urethroplasty (TIPU) using pedicled preputial flap. Recurrent cases, cases with severe chordee which necessitated division of the urethral plate, and cases with penoscrotal hypospadias were excluded from this study.Results: Thirty-seven cases of hypospadias aged 9-60 months with a mean age of 24.8 months were included in this study. Coronal (n= 9 cases; 24.3%), distal penile (n=11; 29.9%), and midpenile hypospadias (n= 17; 45.9%) were detected in respective number of patients. Postoperative complications consisted of external meatal stenosis (n=2; 8.1%), and one case with urethrocutaneous fistula. Skin necrosis was not reported in this study. Follow-up visits were performed at 1, 3 and 6 months which showed good cosmetic appearance that was accepted by their parents. Conclusion:This technique was beneficial in decreasing the rate of skin necrosis, as it keeps the blood supply to the preputial skin intact, and decreases the incidence of urethrocutaneous fistula.Keywords: Hypospadias; prepuce; skin necrosis; urethrocutaneous fistula. ÖZAmaç: Sünnet derisini çift fonksiyonlu kullanmak. Birincisi üretrokutanöz fistül insidansını azaltmak için neoüretranın ikinci katmanı ve ikincisi penisin ventral yüzünü kaplayan deri katmanı olarak kullanmak. Gereç ve yöntemler:Ocak 2013 ile Aralık 2016 arası hafif-orta derecede kordisi olan 37 hipospadiyas olgusu bu çalışmaya dahil edilmiştir. Ventral penis deri defekti olan olgular pediküllü prepisyum flepiyle tübülarize üretral plağın kullanıldığı üretroplasti (TIPU) yöntemiyle tedavi edilmiştir. Nüks olgular, üretral plağın ikiye bölünmesini gerektiren ağır kordili olgularla penoskrotal hipospadiyas olguları çalışmadan çıkartılmıştır.Bulgular: Yaş ortalaması 24.8 ay olan (9-60 ay arası) 37 hipospadiyas olgusu bu çalışmaya alınmıştır. Koronal (n=9; %24,3), distal penil (n=11; %29,9) ve midpenil hipospadiyas (n=17; %45,9) olgusu saptanmıştır. Postoperatif komplikasyonlar eksternal mea stenozu (n=2; %8,1) ve üretrokutanöz fistülden (n=1) ibaretti. Bu çalışmada deri nekrozu bildirilmemiştir. Birinci, 3., ve 6. aylarda gerçekleştirilen kontrollerde hastaların anababalrını da kabul edilebilir bulduğu iyi kozmetik sonuçlar saptanmıştır.Sonuç: Bu teknik sünnet derisine giden kan akımını bozmadığı, üretrokutanöz fistül ve deri nekrozu insidansını azalttığı için yararlı bir teknikti.Anahtar Kelimeler: Hipospadiyas; sünnet derisi; deri nekrozu; üretrokutanöz fistül.

Role of tunica vaginalis flap and dartos flap in tubularized incisional plate for primary hypospadias repair: A retrospective monocentric study

“…In some other method, as in our cases, creating a buttonhole incision in the midshaft skin of the penis, delivering the penis through it, and suturing was made (2,25). Complications of TIP hypospadias procedure include urethrocutaneous fistula formation, stenosis of the new meatus, diverticulum formation, and TVF complications such as scrotal hematoma in the 2% to 4% range.…”

“…It causes the shortens of the penile shafts in the ventral aspect, causing downward deformity of the penis (chordee) (1). Hypospadias is classified into penoscrotal, proximal, midpenile, distal, and coronal hypospadias (2). The techniques used to repair hypospadias are heavily influenced by the anomaly's components, including the size of the urethral plate and penis, the presence of penile chordee, the location of the meatal opening, and the experience of the surgeon (3).…”