Complications of the preputial island flap-tube urethroplasty
Related Experiment Video
Updated: Aug 19, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
1Department of Urology, Suez Canal University, Ismailia, Egypt. elbakry1@eyptnetwork.com
Insights
The transverse preputial island flap-tube repair for hypospadias has a 58% success rate, but a 42% complication rate. This technique is challenging, suggesting onlay procedures may be preferable.
Area of Science:
- Urology
- Pediatric Surgery
- Reconstructive Surgery
Background:
- Hypospadias repair is complex, with various surgical techniques.
- Tubularized preputial island flaps are one method for urethroplasty.
Purpose of the Study:
- To evaluate the long-term functional and cosmetic outcomes of hypospadias repair using tubularized transverse preputial island flaps.
Main Methods:
- Seventy-four patients with hypospadias and chordee underwent transverse preputial island flap-tube repair.
- Mean follow-up was 43 months, assessing functional and cosmetic results.
Main Results:
- Single-stage repair success rate was 58% (43 patients).
- Overall complication rate was 42%, including urethrocutaneous fistula (23%) and strictures (9%).
- All complications were managed successfully with re-operations.
Conclusions:
- The transverse preputial island flap-tube repair is technically demanding with a high complication rate.
- Preserving the urethral plate and considering onlay procedures may be advantageous.
Objective:
To report the long-term results of hypospadias repair using tubularized transverse preputial island flaps.
Patients And Methods:
Seventy-four patients (mean age 7 years, range 2-19) underwent a transverse preputial island flap-tube repair for hypospadias. All patients had chordee, 14 had anterior, 41 mid-penile and 19 penoscrotal hypospadias. The mean (range) follow-up was 43 (14-77) months and the outcome assessed by function and cosmesis.
Results:
The repair was functionally and cosmetically successful in 43 patients (58%) as a single-stage repair. Necrosis and sloughing of the neourethra occurred in five patients (7%), urethrocutaneous fistula in 17 (23%), strictures in seven (9%), diverticula in three (4%) and insignificant urethral misalignment was detected by urethrography in three (4%); thus the overall complication rate was 42%. All of these complications were treated successfully in one or two re-operations.
Conclusions:
The transverse preputial island flap-tube repair of hypospadias is a demanding technique. Even in experienced hands it has a relatively high complication rate. Every effort should be made to preserve the urethral plate during orthoplasty, minimizing the need to use tubularized preputial island flaps and expanding the application of onlay procedures.
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