Background Several techniques have been used to repair
mid-penile hypospadias; however, high failure rates and
major complications have been reported. In this study, we
describe a novel technique using a well-vascularized flap of
the inner and outer preputial skin.
Methods A total of 110 male children with hypospadias
underwent repair by our technique between 2008 and 2015.
The inclusion criteria were children with mid-penile or
slightly more proximal hypospadias, with or without ventral
chordae, and an intact prepuce of the cobra eyes variety.
Recurrent cases, patients with other preputial types, and
circumcised children were excluded from this study. The
prepared flap was sutured in its natural longitudinal orientation
to the created urethral plate strip to form a neo-urethra
over a urethral catheter. Outcome measures included
surgical success without the formation of a urethra-cutaneous
fistula, no ischaemia of the flaps, glans dehiscence or
infection and functional outcome and cosmetic appearance.
Results The median follow-up duration was 3.3 years.
There were 63 cases of mid-penile hypospadias (57.3 %),
and in 47 cases (42.7 %), the meatus was slightly more
proximal. The age of the patients ranged from 1.1 to
8.0 years, with a mean age of 4.6 ± 1.2 years. Surgery was
successful in 106 (96.4 %) cases. Minor complications
occurred in 11 patients (10 %) and included oedema of
glans in ten patients and bluish discoloration on the ventralaspect of the glans close to the suture line in three patients.
All patients improved within 2 weeks after surgery. Longterm
follow-up revealed a properly functioning urethra with
a forward, projectile, single, compact, and rifled urinary
stream of adequate calibre and cosmetically acceptable
repair. No cases of meatal retraction, meatal stenosis, urethral
stricture, or acquired urethral diverticulum occurred.
Discussion Our technique is different from the split prepuce
in situ technique. We create a narrow strip of the
urethral plate that facilitates glanular closure, and we use
the inner and adjacent outer skin in a vertical manner to
preserve excess skin for penile coverage. Prepuce is split
at midline to preserve more preputial skin with favourable
dartos tissue for penile skin coverage. The glans is closed
using a stitch-by-stitch method that has not been described
previously.
Conclusion This study presents a novel technique for midpenile
hypospadias repair using a preputial skin flap with
excellent results in terms of short- and long-term outcomes.