OBJECTIVE To solve the challenge in redo hypospadias surgery, we tried to use a bipedicled dorsal penile flap
with a Z release incision in failed hypospadias cases and reported the outcome.
MATERIALS AND
METHODS
Thirty male children with 3 or 4 previous unsuccessful hypospadias surgeries were included in
our study. Our technique was done after at least 6 months from the last surgery. A flap of the
dorsal penile skin was preserved and the skin lateral to the flap was dissected on each side. A
small opening was done in the dartos proximal to flap. The glans was withdrawn through this
opening with a ventral transposition of the flap. Z-plasty was used to compensate for the deficient
dorsal skin; the Z-plasty had 3 limbs and all were made of equal length.
RESULTS The mean age of the patients was 5.4 ± 1.8 years and the mean follow-up was 2.1 ± 0.7 years. The
technique was successful in 80%. Reoperation was required in 3 cases; all cases were managed
using a 2-stage buccal mucosal graft. A small fistula at the coronal level developed in 2 cases but
closed spontaneously within 1 month. All patients were voiding well and had a vertically oriented
meatus at the tip of the glans and satisfactory cosmetic results.
CONCLUSION Repair of failed hypospadias using a bipedicled dorsal penile skin flap with Z release incision is a
safe and simple procedure offering high success rates.