Urethroplasty Using Transverse Penile Island Flap for Hypospadias

Abstract

We describe a new procedure in which dorsal penile skin is used to correct hypospadias in circumcised patients and those in whom surgical correction usually is difficult. Of 48 hypospadiac patients treated by this technique 26 (54 per cent) had been circumcised previously, while 22 (46 per cent) had undergone a prior hypospadias repair that resulted in marked tissue scarring and fistulas. The procedure is accomplished in 2 stages. In stage 1 the urethra is reconstructed and the penis is buried in the scrotum. Separation is done after an average of 6 weeks (stage 2). The results were satisfactory in 45 patients and in all cases a viable new urethra of adequate caliber and length was created with the end at the tip of the glans. The procedure is simple and safe, and complications were minimal.

Newer Concepts in the Management of Hypospadias and its Complications

“…Though the complication rate has come down in recent years with the newer techniques, complications, especially fistula, are likely to continue for many years (3); reported rates vary from 0% to 69% (12,13).…”

“…The island flap and double island flap give excellent cosmetic results, looking similar to a normal circumcised penis. The complication rates vary considerably and the good results obtained by some (3) are not duplicated by others (12,13). Complication rates vary from 3.7% to 69% (12,13), probably owing to the separation of the island.…”

“…The complication rates vary considerably and the good results obtained by some (3) are not duplicated by others (12,13). Complication rates vary from 3.7% to 69% (12,13), probably owing to the separation of the island. On the other hand, a vascularised transverse preputial flap attached to the outer prepuce but not freed as an island flap is more secure than island flaps (14).…”

One-Stage Penile Cutaneous Island Flap Repair for Hypospadias in Circumcized Patients

“…The successful use of this technique in 2 children who were 2 years old, without magnification aids, points to the great promise this procedure may hold in reducing psychological trauma, which delayed repair may induce in the children and their parents [14,15], A recent article [16] has described the use of penile skin in a two-stage repair of hypospadias in circumcized subjects with considerable success and only 1 case of urethrocutaneous fistula. We did not have any problems with skin cover of the 'degloved' penis and our one-stage procedure saved the patients an extra operation.…”

Proximal Hypospadias

“…However, reported complication rate of fistula formation varies from 17 to 69% [2, 3, 4, 5, 6]. Earlier reports in the 1980s show a variable fistulae rate of 3.7–69% [3, 4, 6, 7]. In the 1990s, the reported fistulae rate was 5–17% with a 6–100% improvement in rate of secondary surgery [2, 5, 8].…”