Onlay island flap urethroplasty: a comparative analysis of primary versus reoperative cases

To compare the outcome of the onlay technique in cases with an untouched urethral plate (group 1) and patients who had undergone previous hypospadias repairs (group 2).

The records of the 50 patients undergoing onlay island flap urethroplasty in the past 10 years were reviewed. The frequency of fistula formation in both groups was compared using the appropriate statistical methods.

Seventeen and 33 patients were enrolled into groups 1 and 2, respectively. No statistically significant difference in patient age was present between the two groups (P >0.05). Flap necrosis in 2 patients and skin necrosis in 1 patient were encountered in group 2, with the meatus located at the penoscrotal region. Ischemic skin changes occurred in one primary patient with a mid-penile meatus. Urethrocutaneous fistula occurred in 2 (11.7%) of 17 primary cases and in 14 (42.4%) of 33 cases with multiple previous operations (Pearson chi-square test, P <0.05). A fistula rate of 61.5% was recorded in group 2 when the urethral meatus was located at the penoscrotal region. After withdrawal of the cases with penoscrotal meatus, the incidence of urethrocutaneous fistula was 6.7% (1 of 15) and 30% (6 of 20) in groups 1 and 2, respectively.

Multiple previous operations affected the outcome of repair with the transverse onlay preputial flap, particularly in cases with a penoscrotal meatus. Repeat hypospadias repairs are more prone to complications.