PURPOSE: It was our aim in this study to develop a technique that is rather simple, overcomes the problems of Devine and Horton glanuloplasty in patients with small glans, and is flexible to be tailored to any hypospadias surgery. METHODS: A total of 11 patients were included in this preliminary report. A triangular skin flap was interpositioned between the developed glanular wings to cover the neourethra. The source of this flap was either the outer preputial skin in eight patients subjected to double onlay preputial flaps and was a skin flap developed from the ventrolateral penile skin in two cases repaired by Snodgrass procedure and another by Mathieu flip flap repair. RESULTS: Cosmetic appearance was good in all cases except one. In this case the distortion of the glans was due to the use of excessive skin for interpositioning. One patient suffered from urethracutaneous fistula that was repaired later. In addition, three patients experienced edema of the interpositioned skin, which was self-limiting. Otherwise, we did not face any meatal regression, glanular dehiscence, repair disruption or any other major complications. CONCLUSION: The interpositioned vascularized skin flap between the developed glanular wings is a promising technique for glanuloplasty. Most of the problems faced with the triangularized glans technique have been solved with our modification. It provides tension-free closure of the glans with improved cosmetic results. This report is preliminary, and long-term data and larger number of patients should be treated with this procedure before a final conclusion is reached.
PURPOSE: It was our aim in this study to develop a technique that is rather simple, overcomes the problems of Devine and Horton glanuloplasty in patients with small glans, and is flexible to be tailored to any hypospadias surgery. METHODS: A total of 11 patients were included in this preliminary report. A triangular skin flap was interpositioned between the developed glanular wings to cover the neourethra. The source of this flap was either the outer preputial skin in eight patients subjected to double onlay preputial flaps and was a skin flap developed from the ventrolateral penile skin in two cases repaired by Snodgrass procedure and another by Mathieu flip flap repair. RESULTS: Cosmetic appearance was good in all cases except one. In this case the distortion of the glans was due to the use of excessive skin for interpositioning. One patient suffered from urethracutaneous fistula that was repaired later. In addition, three patients experienced edema of the interpositioned skin, which was self-limiting. Otherwise, we did not face any meatal regression, glanular dehiscence, repair disruption or any other major complications. CONCLUSION: The interpositioned vascularized skin flap between the developed glanular wings is a promising technique for glanuloplasty. Most of the problems faced with the triangularized glans technique have been solved with our modification. It provides tension-free closure of the glans with improved cosmetic results. This report is preliminary, and long-term data and larger number of patients should be treated with this procedure before a final conclusion is reached.