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AimsTo report current results of preputial flap onlay urethroplasty using the principle of the total preputial flap (TPF) for the one-stage repair of mid- and proximal hypospadias.Methods
This study was a retrospective chart review of patients in a prospectively kept database of all hypospadias operations performed at two institutions from January...
Citations
... [6] Trends have shifted from tiered repairs to one-stage repairs throughout the years. [7] Once hypospadias is paired with severe chordee, urethral plate transection is typically suggested during orthoplasty to guarantee that chordee does not reoccur. According to one study, urethral fibrosis is a contributing factor in two-thirds of individuals with recurrent chordee. ...
... Another retrospective review [14] included 31 patients, mean age 14 years (15 months-26 years), who failed a mean of four prior repairs (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) and presented with a variety of complications, including fistulas, strictures, diverticula, and dehiscence (numbers not stated). Grafts were harvested from prepuce (n = 15) and penile skin (n = 12), with a mean follow-up of 30 months (8-66), complications occurred in five (16%)-four strictures at the proximal junction and one fistula. ...
Background: One of the most frequent urogenital malformations in newborn boys is hypospadias. After undescended testis, in boys, it is the second most popular congenital abnormality. There are different one-stage surgical procedures used to repair proximal hypospadias, each has its own advantages and outcome. One of them is tubularized preputial free graft, which is first tried by the urologist team of Horton and Devine who used full thickness preputial grafts tubularized in a single-stage operation. Aim: The aim of this article is to assess the outcome of a one-stage tubularized preputial free graft. Materials and Methods: The present case series study provides a prospective analysis of 88 proximal hypospadiac boys operated on primarily over more than 5.5 years (from March 2014 to September 2019) using preputial skin as a tubularized free graft in one stage. Ethical approval for this review was obtained. Results: The present study includes 88 boys with hypospadias with mean age 20.6 months (ranging from 5 months to 7.5 years). The proximal hypospadias represents 33 (37.5%), penoscrotal 51 (58.0%), and scrotal 4 (4.5%) boys. Thirty-three boys out of 88 are under 12 years, 29 are between 12 and 24 years, and 26 above 24 years. The postoperative complications reported are fistula which occurs in 9 (10.3%), glans dehiscence in 3 (3.4%), meatal stenosis in 3 (3.4%), and diverticulum in 2 (2.3%), and numbers of complications with respect to age groups were six complications under 12 years, two complications between 12 and 24 years, and nine complications above 24 years. Conclusion: One-stage correction using a tubularized preputial free graft is an appropriate choice for repairing proximal hypospadias with chordee when compared with other widely used procedures for proximal cases.
... The use of the double-island transverse preputial skin tube was a significant advance in the single-stage repair of hypospadias in the 80's [12,13]. Gonzalez et al. described the initial technique of full preputial double face in 1996 and published their recent results in 2018 [14]. ...
... In our experience, all the diverticula were treated by only one surgery to reduce the diverticulum without further complications. It has been suggested by Gonzales et al., that the use of the dorsal skin of the prepuce may avoid this complication [14]. Meanwhile we had only three strictures on a series of 41 severe hypospadias patients (7%), which is a low rate of stenosis in severe hypospadias patients. ...
PurposeWe have studied outcome of double-face preputial island flap (DFPIF) technique in severe types of hypospadias: penoscrotal, scrotal and perineal.Methods
We have used DFPIF in 75 boys at a median age of 1.1 years (1.0–1.5). The meatus was penoscrotal, scrotal or perineal after de-gloving the penis. The inner face of the foreskin was used for urethroplasty and the outer face for ventral skin covering. Modifications were added: proximal anastomosis was protected by a spongioplasty; in case of urethral plate transection, we anastomosed on onlay proximal and distal segments of the flap (onlay-tube-onlay) and the tubularized part was sutured to corpus cavernosa. FU was scheduled at one month then every 3 months for a year then annually. At each consultation, the surgeon filled out a detailed cosmetic and functional sheet including flowmeter.ResultsThirty-four patients had onlay preputial flap repair with urethral plate preservation. Forty-one had the onlay-tube-onlay technique. All children had a curvature, 19 had a significant residual curvature after dissection, corrected by dorsal plication (n = 9) and ventral lengthening (n = 10). Median FU was 4.2 years (2.7–6.5). 36 children (48%) had complications and needed redo surgery: 12 fistulas, 11 diverticula, 7 meatal stenosis, 3 strictures and 2 residual curvatures. All children but three voided within the normal limits for their age.ConclusionDFPIF remains a good option for a one-stage repair of severe hypospadias. After a median of 1.8 procedures, the final success rate was 96%. The healthy well-vascularized ventral skin allows safe redo surgery when needed.
... The objective of surgical correction is to restore normal function and appearance of a penis. Surgical urethroplasty should result in a properly directed urinary stream and a straightened erected penis [7] . ...
... All procedures were conducted by a single surgeon, under general anesthesia and the thirdgeneration cephalosporin was injected with induction of anesthesia in a dose of 50mg/kg body weight and continued for 72 hours post operatively. Then, replaced with oral antibiotic till removal of urinary stent [5][6][7] days. ...
... [6][7][8] At present, the prevailing tendency favors the use of stage repair advocated by Altarac et al. [9][10][11] Barroso et al. [7] reported their series of onlay flap urethroplasty wherein 75% of the children required only one operation for complete resolution of the problem along with durable results at a mean follow-up of 14 years in 30 patients. Similarly, González et al. [12] retrospectively reviewed the charts of patients undergoing hypospadias repair using a preputial only flap urethroplasty. Forty-nine children with marked penile curvature underwent surgery at a mean age of 22 months and with a mean duration of follow-up of 23.4 months (1-79). ...
... [14] One-stage repair of mid-and proximal penile hypospadias preserving the urethral plate is possible using a preputial flap for the urethroplasty and coverage of the ventral penis. [12] González et al. [12] reported a success in 77.5% of cases. They were able to correct the chordee in all of their patients and achieve a straight penis without dividing the urethral plate which allowed the successful use of the onlay technique. ...
... [14] One-stage repair of mid-and proximal penile hypospadias preserving the urethral plate is possible using a preputial flap for the urethroplasty and coverage of the ventral penis. [12] González et al. [12] reported a success in 77.5% of cases. They were able to correct the chordee in all of their patients and achieve a straight penis without dividing the urethral plate which allowed the successful use of the onlay technique. ...
Introduction: We report our results of preputial flap onlay urethroplasty for the one-stage repair of mid- and proximal penile hypospadias with chordee.
Materials and Methods: We retrospectively reviewed the hospital data base for children undergoing onlay flap urethroplasty and hypospadias repair for mid- or proximal penile hypospadias with chordee.
Results: During the study period January 2000–December 2017, 21 children underwent onlay preputial flap urethroplasty. The procedure was successful in 15 (71.42%) children with no need to undergo further procedures or operations. There were five urethrocutaneous fistulas and dehiscence of glans in one.
Conclusions: An onlay urethroplasty using the preputial flap yields results comparable to those of staged techniques and results in fewer procedures under anesthesia in children.
... However, the surgeons must master few different procedures to overcome various troubling circumstances. [15,18,26,27] At present, two-stage repair is recommended for proximal or complex hypospadias and re-operation in patients because it presents reduced post-operative complication rate and increased parent satisfication. [15,[28][29][30][31] Researchers have recommended that more than 50 procedures in a year is sufficient [9,15]; however, the surgical outcomes can be improved by learning from the experiences of skilled surgeons and accordingly modifying the operative details. ...
... However, the disadvantage of TIP method is that [9] the high of incidence of operation complications such as urethral cutaneous fistula, urethral stricture and the recurrence of penile ventral curvature, which is related to the urethral plate of dysplasia, poor blood supply and weak tissue regeneration. Mathieu, Onlay, Koyanagi and other surgical methods [10], because keep the partial or completely reserved the urethral plate, the use of the prepuce and urethral plate tissues with combined flaps repair of hypospadias, have a certain advantages of the keep urethral plate operation for hypospadias repair, that is good clinical treatment effect, better cosmetic appearance of the penis, Satisfactory physiological function. However [11], because of this kind of operation method, did not solve urethral plate and skin tissue flap dysplasia, blood supply insufficiency, the tissue distributes unreasonable and so on, although to a certain extent solves question of the penile curvature recurrence, but the high complication rate of the postoperative as the urethra fistula, urethral stricture, is the main problem of leads to the failure in the operation. ...
The management of proximal hypospadias requires a considerable undertaking by the surgeon. The patient and their family’s expectations include that the reconstructive surgery will deliver a cosmetically normal-appearing penis with an orthotopic meatus that allows for proper urination and minimal chordee or torsion permit pleasurable penetrative sexual intercourse. Additionally, it has to be durable enough to withstand the physiological changes that accompany growth from infancy through adulthood.There has been a recent migration towards repairing proximal hypospadias in a staged manner. There does exist a clinical phenotype of proximal hypospadias that is still amenable to being treated with a single-stage repair and yielding good long-term clinical outcomes—this would include a boy with proximal hypospadias who has minimal chordee (less than 30 degrees), a healthy urethral plate and/or a good size dorsal hood, and adequate healthy penile shaft skin.This chapter reviews the strategy for managing a child with proximal hypospadias, utilizing a single procedure and the reported limitations and outcomes of the procedures that are currently being deployed.
