[A method of one-stage correction of proximal hypospadia by deepithelialized foreskin graft]

The author proposes a modification of one-stage urethral plastic repair with cross-over graft from the foreskin according to Duckett for correction of proximal hypospadias with malformation or absence of the free trunkal part of the penis in well developed foreskin. From 1996 to 2001 one-stage operations were made in 82 boys at the age of 8 months to 15 years. Expanding of the cavernous bodies with loss of the urethral platform and plastic repair of a long urethral area were performed in 69 patients. These cases were most difficult for correction. Only plastic repair was made in the rest 13 children as their cavernous body deformation had been corrected previously. One-stage surgery of the urethra with dissection of the chorda was conducted by Hodgson-III in 13 patients, by modified Hodgson-III technique in 29 and by Duckett in 5 patients. Plastic repair with diagonal deepithelized graft from the foreskin was tried in 22 patients with underdeveloped volar surface of the penis. The modification consisted in cutting out the diagonal graft from the foreskin entoderm, forming a tube of it with uninterrupted suture, creation of the graft vascular pedicle by skeletization and deepithelization of the skin of the foreskin ectoderm and partially of the penis trunk, creation of a wide anastomosis of the formed tube with external opening of the urethra isolated by edge incision, mobilization of the glans penis wings by longitudinal incisions and creation of meatus on the top of the glans penis, mobilization of the foreskin and penis trunk tunica dartos with its placing from the dorsal surface on the ventral at both sides of the cavernous bodies. The treatment outcomes were followed up from 6 months to 3.5 years. Complications (stenosis of the external urethral opening, urethral fistulas and stenosis of the anastomosis zone) were observed in 13 (18.84%) patients. The proposed modification reduced the number of complications up to 13.63%, improved cosmetic and functional results.