'Pseudospongioplasty' in the repair of a urethral diverticulum

To describe a technique for repairing urethral diverticula which includes neourethral reconstruction and increasing the mechanical support of the neourethra.

Between February 1995 and May 2000, 267 patients with proximal hypospadias underwent a one-stage penile skin longitudinal flap urethroplasty. The overall postoperative complication rate was 20%; a diverticulum formed in 24 patients (9%) and in all it was repaired. Diverticulectomy was carried out by de-epithelialization of excess diverticular skin, so that two subcutaneous vascularized tissue wings could be created. After re-establishing distal urethral patency and neourethral closure, the de-epithelialized diverticular wings were folded and overlapped to form a mechanical support for the neourethral ventral wall; this procedure was termed 'pseudospongioplasty'.

There were no recurrences of diverticulum or any fistula formation. The only complication was urethral stenosis in two cases, which was successfully resolved by internal urethrotomy.

Re-establishing patency and providing mechanical support are essential when repairing a urethral diverticulum. Our technique with pseudospongiosal tissue reconstruction during the repair represents a good alternative or addition to other techniques.