Results of preputial reconstruction in 77 boys with distal hypospadias
A J Klijn1, P Dik, T P de Jong
1Department of Pediatric Urology, University Medical Centre Utrecht, Children's Hospital, Utrecht, The Netherlands.
Insights
Preputial reconstruction combined with hypospadias repair can result in an anatomically normal penis, but carries a 33% complication rate. Parents should be informed of these risks before electing this procedure for their child.
Area of Science:
- Pediatric Urology
- Reconstructive Surgery
Background:
- Hypospadias repair is a common pediatric urological procedure.
- Preputial reconstruction is increasingly performed concurrently with hypospadias repair.
Purpose of the Study:
- To evaluate the outcomes of combined preputial reconstruction and hypospadias repair.
- To identify complications, risks, and failure rates associated with the combined procedure.
Main Methods:
- Retrospective analysis of 77 boys undergoing distal hypospadias repair with preputial reconstruction.
- Evaluation of complications, risks, and failures at a mean follow-up of 2.5 years.
Main Results:
- 52 patients (67%) had an anatomically normal penis with a functional foreskin.
- 25 patients (33%) experienced complications, including partial dehiscence and fistulas.
- Complications involved the foreskin (21%), combined foreskin and urethra (9%), or urethra only (3%).
Conclusions:
- Combined preputial and hypospadias repair can achieve anatomical correction but has a significant complication rate (33%).
- Parents are informed of the risks, and 15% have opted for preputial reconstruction in cases of distal hypospadias.
- Reoperation was required for 19 of 25 patients with complications.
Purpose:
There is growing interest in preputial reconstruction combined with hypospadias repair. We retrospectively analyzed its results for future developments and patient information.
Materials And Methods:
We evaluated 77 boys who underwent distal hypospadias repair combined with preputial reconstruction to determine complications, risks and failures.
Results:
At a mean followup of 2.5 years 52 patients had an anatomically normal penis with a normal retractable foreskin, while 25 (33%) presented with a complication. The most common complications were partial dehiscence, and fistula of the prepuce and urethra. There was a complication of the reconstructed foreskin only in 16 cases (21%), a combined problem with the reconstructed foreskin and reconstructed urethra in 7 (9%), and a problem with the reconstructed urethra in 2 (3%). Of the 25 patients with complications 19 underwent reoperation with closure of the fistula or dehiscence and 5 were circumcised, while in 1 the parents accepted the minor cosmetic problem and refused reoperation.
Conclusions:
Preputial repair combined with hypospadias repair may lead to anatomically correct reconstruction of the penis at the cost of a 33% complication rate. Parents are informed about this risk and to date in 15% of all boys with distal hypospadias the parents have elected preputial reconstruction.
