PURPOSE: The repair of penoscrotal or perineal hypospadias with severe chordee may require division of the urethral plate to facilitate repair. While a 2-stage approach to these difficult cases has been advocated, we have used a modified tubularized transverse preputial island flap (TPIF) repair as a 1-stage procedure. We compare our results with both procedures. MATERIALS AND METHODS: Between 1997 and 2001, 1 surgeon (DAC) performed 22 penoscrotal or scrotal hypospadias repairs that required transection of the urethral plate. A TPIF or planned 2-stage repair was done in 12 and 10 boys, respectively. The TPIF was modified by suturing the medial edge of the island flap along the length of the corpora recreating a urethral plate and then tubularizing a neourethra. The 2-stage approach consisted first of mobilizing skin to the ventrum of the penis followed 6 to 12 months later by a urethroplasty. At followup cosmetic and functional results were assessed. RESULTS: The TPIF and staged repair groups have been followed for a mean 24.5 and 43.5 months following the first repair, respectively. Of the 12 boys undergoing a TPIF 2 (16.7%) required a fistula repair or meatoplasty while 7 of 10 (70%) required at least 1 additional operation after the stage 2 urethroplasty (p <0.05). A mean of 1.6 additional repairs following the stage 2 urethroplasty was required. At last followup physical examination demonstrated a straight penis with distal meatus in 19 of 22 boys. Persistent complications include a concealed penis and recurrent fistula in 2 boys following a staged repair and glanular separation in 1 boy following TPIF. CONCLUSIONS: In our experience the staged approach to the repair of severe hypospadias requires significantly more cumulative surgical attempts than the modified TPIF. Indeed, in the majority of our cases the so-called "2-stage hypospadias repair" was a misnomer. The TPIF offers a reliable 1-stage repair. We prefer this approach to staged repairs even for severe hypospadias.
PURPOSE: The repair of penoscrotal or perineal hypospadias with severe chordee may require division of the urethral plate to facilitate repair. While a 2-stage approach to these difficult cases has been advocated, we have used a modified tubularized transverse preputial island flap (TPIF) repair as a 1-stage procedure. We compare our results with both procedures. MATERIALS AND METHODS: Between 1997 and 2001, 1 surgeon (DAC) performed 22 penoscrotal or scrotal hypospadias repairs that required transection of the urethral plate. A TPIF or planned 2-stage repair was done in 12 and 10 boys, respectively. The TPIF was modified by suturing the medial edge of the island flap along the length of the corpora recreating a urethral plate and then tubularizing a neourethra. The 2-stage approach consisted first of mobilizing skin to the ventrum of the penis followed 6 to 12 months later by a urethroplasty. At followup cosmetic and functional results were assessed. RESULTS: The TPIF and staged repair groups have been followed for a mean 24.5 and 43.5 months following the first repair, respectively. Of the 12 boys undergoing a TPIF 2 (16.7%) required a fistula repair or meatoplasty while 7 of 10 (70%) required at least 1 additional operation after the stage 2 urethroplasty (p <0.05). A mean of 1.6 additional repairs following the stage 2 urethroplasty was required. At last followup physical examination demonstrated a straight penis with distal meatus in 19 of 22 boys. Persistent complications include a concealed penis and recurrent fistula in 2 boys following a staged repair and glanular separation in 1 boy following TPIF. CONCLUSIONS: In our experience the staged approach to the repair of severe hypospadias requires significantly more cumulative surgical attempts than the modified TPIF. Indeed, in the majority of our cases the so-called "2-stage hypospadias repair" was a misnomer. The TPIF offers a reliable 1-stage repair. We prefer this approach to staged repairs even for severe hypospadias.
Authors: Erin R McNamara; Anthony J Schaeffer; Tanya Logvinenko; Catherine Seager; Ilina Rosoklija; Caleb P Nelson; Alan B Retik; David A Diamond; Marc Cendron Journal: J Urol Date: 2015-05-09 Impact factor: 7.450