One-stage repair of severe hypospadias using modified tubularized transverse preputial island flap with V-incision suture

Abstract 

Purpose

Although hypospadias repair for preserving the urethral plate is popular among pediatric urologists, applying this procedure to severe hypospadias is controversial. We report the outcome of applying additional modifications to the modified tubularized transverse preputial island flap (TPIF) procedure reported previously [Patel RP, Shukla AR, Austin JC and Canning DA. Modified tubularized transverse preputial island flap repair for severe proximal hypospadias. BJU Int 2005;95:901–4] for repairing severe hypospadias.

Materials and methods

We retrospectively evaluated our series of 22 patients (mean age 17.5months) who underwent the modified TPIF with an additional simple modification of meatoplasty with V-incision suture. Patients were followed for a mean period of 18months.

Results

After releasing the chordee, the hypospadiac orifice was retracted to become penile in five patients (22.7%), penoscrotal in six (27.3%), scrotal in nine (40.9%), and perineal in two (9.1%). The median length of the neourethra was 46mm. One-stage repair was successful in 19 patients (86.4%) without any complications.

Conclusion

Our modified TPIF procedure yielded favorable outcomes functionally and cosmetically with a low postoperative morbidity rate. Such a procedure can be considered useful for repairing severe hypospadias when the urethral plate cannot be preserved.

Keywords: Hypospadias, Modified TPIF, Reconstruction of urethral plate, Complication