One-stage complex primary hypospadia repair combining buccal mucosa graft, preputial flap and tunical vaginalis flap (the three-in-one technique)

Abstract 

Objective

Complex hypospadia repair can be performed according to different strategies, mostly in one or two stages. We present a detailed video of one patient operated according to the three-in-one technique, which combines dorsal buccal mucosa grafting for reconstruction of the incised urethral plate and a preputial flap onlay urethroplasty covered by a tunica vaginalis graft.

Method

After sectioning of the urethral plate to correct ventral curvature, the original plate is anchored to the proximal penile shaft. Buccal mucosa is harvested from the lower lip and sutured to the ventral penile shaft area. A transverse preputial flap is obtained and anastomosed ‘onlay’ to the reconstructed neouretha. The scrotal fascia is opened at the site opposite to the placement of the pedicle of the preputial flap and a careful dissection of the tunica vaginalis and cremasteric tissue is performed. This second flap is used to cover the neourethra and is fixed to the corpora by angular interrupted 6-0 PDS sutures.

Results

Our series of 35 patients resulted in 68.5% success after a single operation, whereas 31.5% needed a second repair.

Conclusion

The technique gives excellent results and can be considered an alternative to one-stage repair in primary cases.

Keywords: Hypospadia, Urethra, Reconstruction, Penile surgery